Public Health and Healthcare

Abstract: Background/Objectives: Acute ischemic stroke (AIS) care depends on rapid, coordinated workflows. This study compared two real-world in-hospital stroke models—a neurohospitalist-led model and a stroke practitioner–led multidisciplinary model—in terms of time metrics, radiological outcomes, and 3-month clinical outcomes in patients undergoing reperfusion therapy. Methods: This retrospective, single-center cohort study evaluated patients across two sequential workflow periods. In the practitioner-led model, trained non-neurologist clinicians coordinated care with a stroke nurse under neurologist supervision. Time metrics included door-to-needle time (DNT) and door-to-puncture time (DPT). Clinical outcomes included intensive care unit (ICU) transfer and 3-month functional outcomes assessed by the modified Rankin Scale (mRS). Results: A total of 573 patients were included (284 neurohospitalist-led, 289 practitioner-led). Baseline NIHSS scores were similar between groups. The proportion achieving DNT <60 minutes was significantly higher in the practitioner-led period (74.0% vs. 52.5%, p<0.001), while mean DNT and DPT were comparable. Early radiological outcomes at 24 hours were similar between groups. ICU transfer rates were significantly lower in the practitioner-led period (17.6% vs. 28.2%, p=0.002). Three-month mRS outcomes did not differ significantly. Conclusions: A structured, practitioner-led multidisciplinary workflow was as safe and efficient as a neurohospitalist-led model. Improved adherence to DNT targets and reduced ICU transfers highlight the importance of system-level organization in optimizing AIS care.

Abstract: Endoscopic submucosal dissection (ESD) has revolutionized the management of superficial colorectal neoplasms, offering superior en bloc resection rates compared with conventional endoscopic mucosal resection (EMR). While ESD has been the standard of care in East Asian countries for over two decades, its adoption in Western countries has been considerably slower, hampered by the steep learning curve, prolonged procedural times, limited training infrastructure, and differences in disease epidemiology. However, recent years have witnessed a paradigm shift, with growing evidence from Western multicenter studies demonstrating outcomes that increasingly approach those reported from high-volume Eastern centers. The landmark RESECT-COLON randomized trial provided level-1 evidence supporting the superiority of ESD over piecemeal EMR for large colorectal polyps. Concurrently, novel training paradigms, technological innovations including traction-assisted devices and artificial intelligence (AI)-guided systems, and evolving societal guidelines from the American Gastroenterological Association (AGA), American Society for Gastrointestinal Endoscopy (ASGE), and European Society of Gastrointestinal Endoscopy (ESGE) are accelerating Western adoption. This state-of-the-art review comprehensively examines the current landscape of colorectal ESD in Western practice, highlighting the evolution of outcomes, training pathways, guideline recommendations, technological advances, and future directions. We provide a critical appraisal of the East–West outcome gap and discuss strategies to bridge this divide, positioning colorectal ESD as an increasingly viable first-line therapy for appropriate lesions in Western endoscopy centers.

Abstract: Background/Objectives: Primary care clinics increasingly receive urgent and semi-urgent requests from patients who may otherwise attend emergency departments or urgent care centres when same-day physician or nurse practitioner appointments are unavailable. A meaningful proportion of emergency department visits involve conditions that could potentially be managed in primary care [1,2], and the Canadian Institute for Health Information reported that 15% of Canadian emergency department visits between April 2023 and March 2024 involved conditions that could potentially have been managed in primary care [3]. This article describes the Registered Nurse Prescriber-led Triage-Treatment-Continuity model developed at Cranston Ridge Medical Clinic in Calgary, Alberta, Canada. Methods: The manuscript is reported as a clinic-based practice innovation and service evaluation using aggregate, non-identifying operational service data. The model includes medical office assistant emergency recognition, RN prescriber-led structured triage, a traffic-light urgency classification system, a booking algorithm, clinical support tools, diagnostic test ordering and prescribing within authorized scope, and communication with the patient's primary care provider through the electronic medical record. No patient-identifiable information, patient-level chart review, interviews, surveys, biological samples, or experimental interventions were used. Under TCPS 2 Article 2.5, quality improvement and program evaluation activities conducted exclusively for assessment, management, or improvement purposes do not constitute research for that policy and do not fall within Research Ethics Board review [4]. Results: During a 12-month service evaluation period from April 2025 to April 2026, 5032 patient calls or encounters were managed through the RN prescriber-led pathway. These encounters are interpreted as internal urgent and semi-urgent primary care capacity and potential diversion, not as confirmed emergency department avoidance. Conclusions: The model reframes triage as an integrated primary care intervention rather than a passive sorting process. Further ethics-approved research is required to evaluate patient-level outcomes, safety events, comparative effectiveness, confirmed health-system utilization effects, and cost-effectiveness.

Abstract: Background: Early childhood caries remains a major public health burden in Thailand, particularly among preschool children, despite the implementation of national oral health policies. With the decentralization of child development centers (CDCs) to local adminis-trative organizations (LAOs), understanding system-level determinants of oral health ser-vice effectiveness has become critical. This study aimed to identify key determinants in-fluencing the effectiveness of oral health care systems for preschool children within CDCs in northeastern Thailand. Methods: A cross-sectional analytical study was conducted among 270 stakeholders across urban, peri-urban, and rural CDCs in Ubon Ratchathani Province. Participants were selected using multi-stage random sampling. Data were col-lected between November 2023 and January 2024 using a structured questionnaire with established content validity (IOC > 0.50) and reliability (Cronbach’s alpha = 0.71–0.77). Variables were organized within an Input–Process–Output (IPO) framework. Descriptive statistics, Pearson’s correlation, and multiple linear regression analyses were performed to identify significant predictors of system effectiveness. Results: The oral health care system demonstrated strong performance in preventive service delivery, including universal oral health examinations and fluoride varnish application (100%), and high personnel readi-ness (99.63%). However, critical gaps were identified in monitoring and evaluation sys-tems (8.15%), budget adequacy (60.37%), and continuity of treatment follow-up (48.89%). The prevalence of dental caries among preschool children was 57.83%. Multiple regression analysis revealed that service delivery processes (β = 0.458, p < 0.001) and home visits by public health and dental personnel (β = 0.303, p = 0.008) were significant determinants of system effectiveness, jointly explaining 11.1% of the variance (R² = 0.111). Conclusions: The effectiveness of preschool oral health care systems in decentralized settings is driven pri-marily by the quality of service delivery processes and the integration of proactive commu-nity outreach through home visits. Strengthening monitoring and evaluation mechanisms, ensuring sustainable financing, and enhancing continuity of care between CDCs and households are essential for improving oral health outcomes. These findings provide ac-tionable evidence for policymakers and local health administrators seeking to optimize oral health systems under decentralized governance structures.

Abstract: Background: Seasonal influenza prevention in young adults is influenced by access, trust, and vaccine information exposure, but local evidence linking vaccination uptake with illness and economic burden is limited. Methods: We conducted a cross-sectional electronic survey of adults aged 18-49 years who lived, worked, or studied in the San Francisco Bay Area during the 2025 to 2026 influenza season. Measures included vaccination uptake, influenza-like illness, recovery, functional and economic burden, vaccination sites, and vaccine information exposure. Multivariable logistic regression examined factors associated with vaccination uptake; Kaplan-Meier and Cox models examined time to recovery. Results: Of 554 responses, 463 were included. Vaccination uptake was 86.2% (n=399; 95% confidence interval [CI], 82.7%-89.2%), and 38.4% reported influenza-like illness. Among those with illness, median recovery time was 5 days, median missed work or school was 2 days, and median direct out-of-pocket cost was US$20. Prior season vaccination (adjusted odds ratio [aOR], 2.24; 95% CI, 1.15-4.34) and greater trust in Centers for Disease Control and Prevention or public health agencies (aOR, 1.46; 95% CI, 1.05-2.02) were associated with vaccination. Pharmacies were the second most common vaccination site and preferred future site. Conclusion: Influenza prevention for young adults may benefit from pharmacy-inclusive, multichannel access paired with trusted communication.

Abstract: Physical activity is a safe and effective intervention for chronic musculoskeletal pain. However, a literature search revealed a lack of synthesis of evidence on the extent to which physical therapists in Saudi Arabia incorporate physical activity as part of health promotion in the management of such pain. This review aims to identify, map and report literature related to physical activity for health promotion in people with chronic musculoskeletal pain presenting to physical therapy settings in Saudi Arabia. A six-step approach will be followed to conduct the scoping review. Step 1, the primary research question is: What is the scope and nature of the existing literature in this research area? The secondary research question is: What insights does the existing literature reveal regarding physical therapy clinical practice? Step 2, a comprehensive search will be conducted for relevant literature using the following electronic databases: Scopus, Medline, PubMed, Cochrane library, CINAHL, ScienceDirect and PEDro. In addition, supplementary search methods will be conducted for identifying additional relevant literature via screening process of the reference lists of all included literature and screening process of the included studies of retrieved systematic reviews through electronic databases. A parallel search including the main keywords will also be undertaken on the website of the Saudi Ministry of Health, the website of Saudi Physical Therapy Association, Google and Google Scholar for grey‑literature searching. Step 3, records will be screened by two independent reviewers and managed using Rayan software. Step 4, the nature of included literature, including study characteristics and outcomes where appropriate, will be documented using a data extraction. Step 5, the characteristics and outcomes of included records will be collected, summarised and reported. Step 6, Stakeholders will be consulted to interpret the scoping review findings from their perspective and assess the findings’ relevance and applicability.

Abstract: Background: Medical training is characterized by high academic demands and sustained exposure to stressors. Although the literature suggests robust links between personality and mental health, fewer studies have examined how broad personality traits relate to multidimensional psychological well-being (PWB) among medical students. Methods: In a cross-sectional paper–pencil survey conducted among 115 Polish medical students, personality was assessed with the NEO-FFI (Neuroticism, Extraversion, Openness, Agreeableness, Conscientiousness) and psychological well-being with the 84-item Ryff Psychological Well-Being Scales (autonomy, environmental mastery, personal growth, purpose in life, positive relations, self-acceptance). Descriptive statistics, Pearson/Spearman correlations, and multiple linear regression were applied (α = 0.05). Results: Mean global PWB was moderate-to-high (M = 4.22, SD = 0.57; 1–6 scale). The highest subscale means were personal growth (M = 4.48), purpose in life (M = 4.44), and positive relations (M = 4.41); the lowest were autonomy (M = 3.98), environmental mastery (M = 3.91), and self-acceptance (M = 4.09). Conscientiousness and Extraversion correlated positively with PWB dimensions, whereas Neuroticism showed consistent negative associations. In regression models, Conscientiousness (β = 0.482, p < 0.001) and Extraversion (β = 0.347, p < 0.001) jointly explained 38.7% of global PWB variance; Neuroticism alone predicted 32.4% of variance (β = −0.569, p < 0.001). No significant sex differences in PWB were observed. Conclusions: Personality traits—especially lower Neuroticism and higher Conscientiousness and Extraversion—are strongly linked with better psychological well-being among medical students. Screening and tailored, trait-informed preventive programs (e.g., emotion regulation for high Neuroticism; study planning for lower Conscientiousness; social connectedness for lower Extraversion) may support mental health in medical schools.

Abstract: Background and Objectives: Suicide represents a major global public health concern, involving complex interactions between sociodemographic and clinical factors. Understanding these characteristics at a regional level is essential for the development of targeted prevention strategies. Materials and Methods: We conducted a retrospective observational study including 210 confirmed suicide deaths recorded at a single forensic center between 2023 and 2025. Sociodemographic variables (age, sex, education, marital status, and employment) and toxicological findings (alcohol presence) were collected. Descriptive statistics and inferential analyses, including chi-square tests and multivariate logistic regression, were performed to examine associations between these variables and suicide characteristics, particularly the method of suicide. Results: The study population was predominantly male (82.86%). Hanging was the most frequent method of suicide. Alcohol was detected in 43.81% of cases. Although variations were observed across demographic groups, multivariate logistic regression did not identify statistically significant independent predictors of suicide method (male sex: OR = 1.98, p = 0.122; age: p = 0.579; alcohol presence: p = 0.728). Conclusions: Sociodemographic and toxicological factors contribute to the characterization of suicide deaths; however, no independent predictors of suicide method were identified. These findings highlight the complexity of suicide behavior and underscore the importance of integrating clinical, behavioral, and public health approaches to suicide prevention, including the responsible communication of suicide-related findings.

Abstract: Background: During menopause, many women deal with a "double whammy" of hot flashes and depression. While we know each issue drives up doctor visits and costs, we still don't have a clear picture of the total financial toll when they occur together. Using nationwide U.S. data to break down this combined economic burden is an area that's wide open for more research. Methods: We conducted a retrospective cross-sectional analysis of pooled 2017–2022 Medical Expenditure Panel Survey (MEPS) data, including 22,042 U.S. women. Participants were categorized as VMS with depression, VMS without depression, or no VMS/no depression (reference). Outcomes included total annual healthcare expenditures, outpatient, emergency, and prescription expenditures, and healthcare utilization (outpatient visits, emergency department visits, inpatient hospitalizations). Survey-weighted generalized linear models with a gamma distribution and a log link were used for expenditures. In contrast, survey-weighted linear and count models were used for utilization, adjusting for demographic, socioeconomic, insurance, regional, year, and comorbidity burden. Results: Among 22,042 women, 529 (2.4%) had VMS with depression, and 268 (1.3%) had VMS without depression. The sample included 22,042 women with no VMS or depression, 529 with VMS and depression, and 268 with VMS without depression. Women with VMS and depression had the highest annual healthcare expenditures compared with women without VMS or depression. In multivariable analyses, women with VMS and depression had healthcare costs approximately 1.90 times higher than the reference group (β=0.64, SE=0.08, p< 0.0001; $11,404 vs. $6,002). Those with VMS without depression faced costs approximately 55% higher (β = 0.44, SE = 0.10, p < 0.0001; $9,303 vs. $6,002). Outpatient costs were also significantly higher among women with VMS and depression (β=0.31, SE=0.05, p< 0.0001), corresponding to approximately 36% higher outpatient costs over those with no VMS/no depression, respectively; $2,354 vs. $1,730). Women with both vasomotor symptoms (VMS) and depression had prescription drug spending that was about 2.61 times higher than those without VMS or depression (β = 0.96, SE = 0.13, p < 0.0001; $3.452 vs $1,323). Emergency department costs did not differ significantly between groups. Older age, unemployment, and higher comorbidity burden were also associated with increased healthcare costs. In utilization models, women with VMS and depression had 4.80 additional outpatient visits per year (SE = 0.50, p < 0.0001) and higher emergency department visit rates (β = 0.26, SE = 0.11, p < 0.05), corresponding to approximately 28% higher ER use, whereas inpatient hospitalizations were not significantly different. Women with VMS without depression also had more outpatient visits (β = 3.77, SE = 0.66, p < 0.0001) but no significant differences in emergency or inpatient utilization. Conclusions: VMS and depression are strong independent predictors of increased healthcare expenditures and outpatient utilization among midlife women in the United States. The excess economic burden is driven primarily by outpatient care and prescription use rather than hospitalization, suggesting that integrated menopause and mental health care may improve efficiency and reduce healthcare costs.

Abstract: Background/Objectives: Artificial intelligence (AI) is integrated into diagnostic, thera-peutic, administrative, and communicative healthcare domains in Italy under regulations requiring human oversight. Empirical evidence on AI attitudes, acceptance, and per-ceptions in Italian healthcare is rapidly accumulating but not systematically mapped. This scoping review aimed to (i) map empirical evidence on AI attitudes, acceptance, and perceptions in Italy by population and domain; (ii) identify measurement instruments used in studies and their origins; and (iii) characterize determinants, themes, and methodological gaps in the Italian evidence base. Methods: The review used Joanna Briggs Institute methodology, reported via PRISMA-ScR (protocol Open Science Framework doi: 10.17605/OSF.IO/TZRVF). PubMed and Embase were searched on 27 April 2026 from January 2018 in English, Italian, or German, combining controlled vo-cabulary and free-text terms across AI, attitudes-acceptance, and healthcare delivery, with an Italian-context qualifier. Eligibility criteria used the Population–Concept–Context mnemonic. Results: Of 1,510 unique records screened, 35 empirical studies were retained, comprising seven studies of Italian patients and the general population, 22 studies of healthcare professionals, three psychometric validation studies of AI-acceptance instru-ments, one mixed-population study and two international comparator studies with sub-stantial Italian sub-samples. Acceptance was consistently positive but conditional on physician oversight, training and regulatory clarity. A recurrent optimism–knowledge gap and an absence of probabilistic, population-representative evidence were identified as principal gaps. Conclusions: Italian evidence on AI attitudes is expanding but methodologically narrow. Three Italian-validated acceptance instruments are now available. Population-representative, multilingual and longitudinal evidence is required.

Abstract: Sparganosis is a zoonotic parasitosis associated with freshwater aquatic environments, prevalent in tropical and subtropical regions of the world. Spirometra (S.) mansoni causes sparganosis in humans and spirometrosis in domestic dogs, which is transmitted through the consumption of raw or undercooked meat from fish, frogs or paratenic animals, producing subcutaneous and tissue infections in humans, whereas dogs or cats develop gastrointestinal infections. The purpose of this investigation was to identify S. mansoni in domestic dogs from riverine sectors of the Daule River in Ecuador, using coproparasitological methods: direct examination, flotation and sedimentation with centrifugation using saline solution (as screening); and for confirmation, morphometric methods and PCR were used. Through a descriptive, prospective and cross-sectional study, 402 domestic dogs were analyzed, and Spirometra mansoni were determined in 17% of the collected samples. Clinical and epidemiological characteristics of spirometrosis in dogs and the risk of sparganosis in humans were determined, revealing a profound lack of information and knowledge about the infection; consequently, there is a possibility that cases will spread in pets and that humans will develop sparganosis.

Abstract: Growing evidence suggests that optimized nutritional status and regular physical activity enhance immunotherapy responsiveness by modulating immunometabolism, improving T-cell function, reducing chronic inflammation, and favorably shaping the gut microbiota. Cancer-related metabolic dysfunction and treatment-induced cardiotoxicity converge to impair both skeletal and cardiac muscle energetics, thereby limiting treatment tolerance and effectiveness. Lung cancer (LC) patients frequently present with malnutrition, systemic inflammation, sarcopenia, and pre-existing cardiovascular disease (CVD), conditions that not only compromise functional status and survival but also represent significant competing risks to oncologic outcomes. By counteracting sarcopenia and malnutrition, lifestyle interventions may also reduce immune-related adverse events (irAEs) and mitigate cardiovascular (CV) toxicity, ultimately allowing patients to sustain effective treatment intensity. This narrative review examines the emerging role of targeted nutritional strategies and structured physical exercise as integral components of supportive care in LC, with a specific focus on their impact on cardiac metabolism, CV risk, and response to anticancer therapies, including immunotherapy. In this context, exercise and appropriate dietary interventions emerge as modifiable factors capable of restoring metabolic flexibility, improving mitochondrial function, and reducing systemic inflammation. These effects are particularly relevant in patients receiving immune checkpoint inhibitors (ICIs), where metabolic health and immune competence are tightly interconnected and trained immunity may be a key issue. Finally, the review discusses future challenges and perspectives, emphasizing the impact of CVD on long-term LC survivors’ outcome and of allostatic load and financial toxicity on adherence to lifestyle interventions. The integration of personalized nutrition and exercise programs into cardio-oncology care pathways is proposed as a key strategy to enhance immunotherapy efficacy, improve cardiometabolic resilience, and translate prolonged survival into better quality of life.

Abstract: Adhering to physical activity and diet, risk factors for non-communicable diseases, is important in the management of treatment and medications for chronic conditions, such as diabetes and hypertension. With this aim, this study examines the perceived determinants influencing adherence to and maintenance of these two behavioral risk factors while individuals manage their chronic conditions. Within a planetary health equity framework, a phenomenological approach was taken in a qualitative study to explore the perceived determinants and their interlinkages that collectively shape behavioral adherence to walking and dietary practices among individuals diagnosed with diabetes and hypertension in a single neighborhood. A total of twenty in-depth interviews were conducted. This study found that individual, social, economic, and environmental determinants and their interlinkages made adherence to the physical activity and diet advised by treating physicians challenging and complex. This study also found that behavioral adherence goes beyond individual choice; material and spatial circumstances also play a key role in adherence and maintenance of changing behaviors. Therefore, behavior change without improving these underlying determinants is likely to have less impact on adaptation to walking and diet. A planetary health equity approach that addresses the nexus between human health, society, and the environment must be adopted to resolve the critical challenges in adhering to behavioral change and its maintenance. Intervention strategies must act beyond clinic-based medication and counseling to, through a whole-community and whole-systems approach, integrating primary healthcare, urban planning, environmental governance, and socioeconomic protection.

Abstract: Background/Objectives: Intubation and tracheostomy were previously considered dis-tinct approaches to airway management during mechanical ventilation. Ventila-tor-associated pneumonia (VAP) remains a leading cause of morbidity and mortality in patients requiring prolonged mechanical ventilation. The role of tracheostomy in modify-ing VAP risk is controversial, especially when taking into account how exposure changes over time and the conditions typically found in real intensive care unit (ICU) settings. This study was conducted to evaluate whether tracheostomy timing influences the VAP risk and hospital length of stay in patients undergoing prolonged mechanical ventilation. Methods: We conducted a hybrid case–cohort study in a tertiary-care ICU in Mexico City, enrolling patients receiving invasive mechanical ventilation for ≥ 48 h (January–December 2023). Patients undergoing a tracheostomy were compared with an age- and sex-matched subcohort of intubated patients. VAP incidence was evaluated using cumulative incidence and incidence density. Multivariable generalized linear models, Kaplan–Meier survival analysis, and Cox regression were used to identify risk factors and assess time-to-event outcomes. Results: A total of 218 patients were included (55 tracheostomies vs. 163 intu-bations). The incidence density of VAP was similar between groups (31.5 vs. 30.3 per 1000 ventilator-days; RR 1.04, 95% CI 0.7–1.7). However, cumulative incidence was higher in tracheostomized patients (61.8% vs. 22.7%; RR 2.7, 95% CI 1.9–3.9), reflecting prolonged exposure. Independent risk factors included broad-spectrum antibiotics, mechanical ven-tilation ≥ 5 days, chronic pulmonary disease, and ICU stay. In contrast, tracheostomy was associated with a lower time-dependent hazard of VAP (HR 0.43, 95% CI 0.25–0.75). Gram-negative microorganisms predominated, with higher antimicrobial resistance in tracheostomized patients. A class-based analysis showed that MDR was primarily driven by E. coli, with consistent resistance to cephalosporins and fluoroquinolones. The MAR index was higher in tracheostomized patients (0.50 vs. 0.25), indicating a greater burden of antimicrobial resistance. Conclusions: Tracheostomy increases cumulative VAP inci-dence due to longer exposure but is associated with a reduced time-dependent risk. These findings highlight the importance of accounting for exposure time and support targeted strategies integrating airway management and antimicrobial stewardship to reduce VAP burden in real-world ICU settings.

Abstract: Background: Community-based mental health and social interventions focusing on housing stability, integrated care and psychosocial support are increasingly recognised as essential for improving the mental health and wellbeing of people experiencing homelessness. This review synthesizes how these interventions address mental health and social determinants of health. Methods: Following PRISMA 2020 guidelines, a search of six electronic databases (2019–2025) was conducted (PROSPERO: CRD420250653260). The review included 29 quantitative, qualitative, and mixed-methods studies examining community-based interventions for people experiencing homelessness and mental health conditions. Results: Community-based interventions, particularly Housing First models, were consistently associated with improved housing stability, mental health outcomes, and programme retention. Integrated multidisciplinary services and outreach promote psychosocial wellbeing, continuity of care and reducing emergency service use. Peer-led programs support social integration, although evidence for technology-based tools remains mixed. Conclusions: Addressing social determinants of health through structured community-based interventions is essential to tackle mental health inequalities. The findings highlight the importance of multidisciplinary and mental health nursing approaches that support continuity of care, psychosocial wellbeing, and social inclusion within vulnerable populations.

Abstract: (1) Background: Tungiasis is a cutaneous ectoparasitosis caused by the penetration of gravid female Tunga penetrans fleas into the epidermis. Although endemic in tropical and subtropical regions, it remains rare in Europe, where most cases are travel-associated and secondary household transmission is seldom documented. This study describes imported tungiasis in Greece and investigates possible secondary household transmission in a non-endemic setting. (2) Methods: Seven Greek men residing in Attica developed tungiasis following occupational exposure in Tanzania, together with one secondary case in a non-travelling household contact who had never travelled outside Greece. Diagnosis was based on clinical and dermoscopic findings and confirmed by amplification and sequencing of the mitochondrial cytochrome oxidase I (COI) gene. Household investigations were also performed. (3) Results: Eight male patients presented with painful plantar and/or subungual nodular lesions. Sequence analysis of COI demonstrated 657/662 bp (99%) identity with the Tunga penetrans reference sequence, and identical sequences were identified in all samples. All patients exhibited mild-to-moderate elevations of hepatocellular and cholestatic liver enzymes, which resolved within two weeks following treatment. Only one secondary household case was identified, and no infestation was detected among additional cohabitants or companion animals. (4) Conclusions: This report documents imported tungiasis with probable secondary household transmission in Greece and highlights the importance of clinical awareness and environmental assessment in non-endemic settings.

Abstract: (1)Background: Burn injuries lead to long-term physical, psychological, and functional sequelae, with socioeconomic, clinical, and health system factors contributing to inequities in outcomes. Chronic neuropathic pain, fragmented care, and limited access to rehabilitation remain persistent challenges, particularly among vulnerable populations. (2) Methods: A scoping review was conducted following PRISMA-ScR guidelines, searching PubMed, Scopus, Web of Science, and ScienceDirect for studies published between 2010 and 2026 in English, Spanish, or Portuguese. Thirty-one studies were included, encompassing quantitative, qualitative, mixed-methods research, literature reviews, guidelines, and reports addressing continuity of care and follow-up after skin grafting in burn patients of any cause or age. Data were extracted independently and synthesized using descriptive and narrative approaches. (3) Results: The incidence of chronic neuropathic pain was 6%, often refractory and associated with smoking and substance use, with gabapentin and ascorbic acid showing significant pain reduction. Structured follow-up programs improved quality of life and psychosocial outcomes but did not reduce readmissions. Indigenous populations experienced greater severity and complications, while approximately half of the patients were at risk of post-traumatic stress disorder linked to body image dissatisfaction. Telemedicine reduced access barriers, yet delays in specialized care contributed to contractures and pathological scarring. Early rehabilitation mitigated functional disability, though gaps persist in pain management, psychosocial support, and continuity of care. (4) Conclusions: Post-burn recovery is a multidimensional process requiring structured follow-up, early rehabilitation, telemedicine, and culturally adapted interventions to promote equity and patient-centered outcomes. Keywords: Burns; Chronic neuropathic pain; Postoperative follow-up; Rehabilitation; Health inequities; Pa-tient-centered outcomes.

Abstract: Background/Objectives: Advanced heart failure is associated with reduced functional capacity and impaired quality of live. Left ventricular assist devices (LVADs) are increasingly used as a long-term treatment option in patients with end-stage heart failure. Despite improvements in hemodynamic function after LVAD implantation, many patients continue to experience limitations in daily functioning. The aim of this study was to evaluate the relationship between physical activity and functional status in patients with LVAD support. Methods: The study included 262 adult participants divided into four groups according to LVAD support and declared physical activity. Functional status and quality of life were assessed using the Short Form-36 Health Survey (SF-36) and the Minesota Living with Heart Failure Questionnaire (MLHFQ). Results: Significant differences were observed between the analyzed groups in both SF-36 and MLHFQ scores. Physically active patients with LVAD achieved the most favorable results, indicating better functional status and lower symptom burden, whereas inactive individuals demonstrated poorer outcomes. Significant correlations were found between physical activity and selected aspects of daily functioning, including walking, climbing stairs, household activities, and carrying groceries. Higher levels of physical activity were associated with better quality of life and fewer functional limitations. Conclusions: Physical activity may positively influence functional status and quality of life in patients with LVAD support. The findings suggest that regular physical activity should be considered an important component of rehabilitation and long-term management in patients with advanced heart failure treated with LVAD therapy.

Abstract: Hantaviruses are emerging zoonotic pathogens that represent a significant global threat due to their expanding geographic distribution, broad host range, and potential to cause severe disease in humans. These viruses are primarily transmitted via aerosolized excreta from infected rodents, although insectivores and bats have also been identified as potential reservoirs. Human infections can lead to two main clinical syndromes: hemorrhagic fever with renal syndrome (HFRS), which is predominantly reported in Europe and Asia, and hantavirus cardiopulmonary syndrome (HCPS), primarily occurring in the Americas. Several factors contribute to the rising incidence and spread of hantavirus infections worldwide, including climate change, environmental disturbances, urbanization, habitat alteration, and increased human-animal interactions. This mini-review synthesizes current understanding of hantavirus epidemiology, pathogenesis, diagnosis, treatment, and prevention, highlighting their growing importance within the One Health framework.

Abstract: Objective. Non-communicable diseases (NCDs) are major contributors to morbidity and mortality in Thailand, yet the effectiveness of lifestyle counselling within routine practice is underexplored. This rapid realist review examined how, for whom, and under what circumstances lifestyle counselling supports behaviour change among Thai adults. Design. Rapid realist review following guidance from the Realist and Meta-narrative Evidence Synthesis: Evolving Standards. Setting. Lifestyle counselling and health-coaching interventions for NCD prevention and management delivered in Thai primary care, community settings, or digitally supported programmes. Data sources. Six international and Thai databases (Scopus, Google Scholar, ProQuest, PubMed, EMBASE (Ovid), ThaiJo) were searched for studies published between 2005 and 2025. Eligibility criteria. Empirical studies involving adults (≥18 years) in Thailand that described lifestyle counselling or coaching interventions for NCD-related prevention or management and reported outcomes. Data extraction and synthesis. Data were extracted to identify contexts (C), mechanisms (M), outcomes (O), and equity considerations. These were synthesised into context–mechanism–outcome configurations (CMOCs) and helped to form programme theories. Two Thai doctoral students with community health experience provided public involvement feedback on cultural relevance and feasibility. Results. Thirteen studies were included. Nineteen explanatory configurations were identified across six mechanisms: self-efficacy, social support, motivation, accountability, emotional resilience, and relevance and engagement. Mechanisms were strengthened by family-centred education, routine self-monitoring with feedback, culturally or literacy-tailored materials, and brief stress-regulation strategies. Barriers included low health and digital literacy, conflicting norms, short programme duration, and rural workforce constraints. Facilitators included plain-language materials, low-tech or hybrid follow-up, co-designed dietary strategies, and task-sharing with village health volunteers and family members. Public contributors emphasised cultural alignment, feasibility, and equity. Conclusions. Lifestyle counselling in Thailand operates through six key mechanisms shaped by cultural norms, family dynamics, village health volunteers and service capacity. Effective programmes should prioritise long-term, low-intensity support; cultural and literacy tailoring; and hybrid low-tech maintenance. These findings provide theory-driven guidance for designing and implementing future lifestyle counselling interventions.