Public Health and Healthcare

Abstract: The act of receiving and giving help is commonly expected to improve older people’s health. In this article, this expectation is explored through a longitudinal analysis of a representative sample of 29,995 respondents aged 59 to 89 in 2011 from 12 European countries documented in the Survey of Health, Ageing and Retirement in Europe (SHARE) for the period 2011 to 2022. An unordered correlated random-effects (CRE), an ordered fixed-effects logistic (FEO), as well as an ordered random-effects logistic panel estimator (REO), all with longitudinal calibrated weights, are used to estimate the relationship between self-perceived health, receiving, and giving help. Additionally, a stereotype ordered logistic estimator (SO) is included to support the detected interaction effect between receiving and giving help. Overall, the study documents the positive impact on self-reported health status of income, doing activities and being satisfied with life, as well as the negative impact of age and having limitations. The Danish older people report the best health status, followed by the Swedes and the Swiss. Moreover, the study highlights that receiving help relates to worse self-perceived health, and that giving help relates to better self-perceived health. Above all, the study reveals the potential of the act of giving help to improve the self-perceived health status, in particular of those who receive help.

Abstract: Ecotoxicological and occupational health hazards triggered by pesticide usage are strictly linked to the technical wear of application equipment. This study applies the industrial FMECA (Failure Mode, Effects, and Criticality Analysis) methodology to a pool of 294 knapsack sprayers operated in vegetable farming across three key zones of Côte d'Ivoire (Abidjan, Bouaké, Korhogo), alongside an assessment of growers' cognitive risk boundaries. Technical audits expose that 85% of sprayers are defective, reaching 88% in Abidjan. Pumping lever jams (211 cases), cracked tanks (105 cases), and unsealable caps (111 cases) emerge as primary structural anomalies. The FMECA approach ranks unnoticeable nozzle orifice expansion (Criticality = 40) and leaking tank caps (Very High Criticality = 48) as priority operational hazards inducing involuntary overdosing and direct dermal operator exposure. Simultaneously, a deep cognitive dissonance was documented: 96% of Abidjan market gardeners implement no water resource protection measures, undermining chemical toxicity for short-term financial trade-offs. Urgent equipment calibration and participatory safety protocols are highly critical.

Abstract: Background: Performance evaluation in MRI diagnostics traditionally focuses on op-erational metrics (e.g., waiting times), neglecting patient experience, which funda-mentally determines patients' future healthcare compliance. The aim of our study was to identify the key factors determining patient satisfaction, with particular regard to human interactions and the psychological impacts of the examination environment. Methods: A cross-sectional questionnaire survey was conducted at eight public diag-nostic centers in Hungary (N = 742). Predictors of overall satisfaction were analyzed using multivariate linear regression (IBM SPSS 27.0), examining the effects of structural (waiting list), environmental (noise, isolation, hygiene), and interpersonal (professional competence, information provision) variables (p < 0.05; 95%CI). Results: The model explained 48.8% of the variance in patient satisfaction. The most significant positive predictor was the competence of the healthcare staff (β = 0.349; p < 0.001), followed by confidence in the effectiveness of the examination (β = 0.208) and hygiene (β = 0.128). The distressing effect of loneliness (isolation) was identified as a key negative factor (β = -0.131; p < 0.001). In contrast, waiting time and acoustic load (noise) were not signifi-cant confounding factors in the final model. Conclusions: Our findings highlight that, according to patients' subjective experiences, the quality of radiological care is deter-mined by human factors and clinical trust rather than operational speed. To improve patient satisfaction, emphasis should be placed not only on technical advancements but also on enhancing staff communication competencies and mitigating the experience of isolation during examinations.

Abstract: Infant feeding practices have environmental consequences that are largely absent from climate policy discussions. Breastfeeding relies on maternal metabolism and local support systems, whereas commercial milk formula depends on dairy production, industrial processing, packaging, and extensive supply chains. Comparative analyses report higher greenhouse-gas and water burdens for commercial milk formula than for breastfeeding. Globally, commercial milk formula use among infants under 6 months of age adds roughly 5.9-7.5 billion kg of carbon dioxide equivalent (CO2e) annually. Pumping and bottle-feeding add material, electricity, and cleaning-related burdens relative to feeding at the breast, but the magnitude of these impacts is far less than that of commercial milk formula. Climate change and water insecurity can also threaten breastfeeding through heat stress, food insecurity, and disruptions during disasters and emergencies. Moreover, uncontrolled formula donations during upheavals, while well-intended, impede continuation of breastfeeding. Collectively, these pressures can generate a feedback loop: climate shocks undermine breastfeeding, increasing reliance on resource-intensive substitutes that further strain water and energy systems. Recognizing breastfeeding as both a mitigation and resilience issue highlights co-benefits for child health and climate action and points to practical policy levers, including paid maternity leave, workplace lactation protections, responsible marketing of commercial milk formula, and continuity of lactation support during emergencies that are needed to align optimal infant feeding with climate adaptation planning.

Abstract: Indigenous youth in Canada experience disproportionately high rates of suicide, highlighting the need to identify protective factors that support wellbeing. This study examined the association between structured physical activity and suicidal ideation among Indigenous youth participating in the Smart Indigenous Youth (SIY) initiative. Cross-sectional survey data from 64 youth aged 13–18 years from two rural First Nations communities in Saskatchewan were analyzed. Structured physical activity was categorized as low (0–2 days/week) or high (3+ days/week), and suicidal ideation was assessed as a binary outcome. Analyses included descriptive statistics, age- and gender-stratified descriptives, Fisher’s and stratified Fisher’s exact tests, and logistic regression models. Higher levels of structured physical activity were associated with reduced odds of suicidal ideation in adjusted models (OR = 0.33, 95% CI [0.12, 0.97], p = .043). Bivariate and stratified analyses demonstrated consistent protective trends, although these did not reach statistical significance. Descriptive findings indicated similar physical activity participation across age groups, with slightly higher prevalence of suicidal ideation among older youth. These findings suggest that structured physical activity may represent a protective factor for suicidal ideation among Indigenous youth and highlight the importance of considering developmental and contextual factors in youth health research.

Abstract: Introduction: HL7 Fast Healthcare Interoperability Resources (FHIR) has emerged as a leading global standard for health information exchange and is increasingly central to national digital health architecture and to interoperability across the wider health ecosystem. In India, FHIR underpins key national digital health programmes, including the Ayushman Bharat Digital Mission (ABDM) and the National Health Claims Exchange (NHCX). However, the practical, ecosystem-wide adoption of FHIR beyond national programme requirements has not been systematically assessed.Methods: We conducted a mixed-methods landscape assessment between September and October 2025. Data sources included a structured online survey of ecosystem participants (n=22) representing health information system vendors, hospitals, insurers, third-party administrators, diagnostic laboratories, start-ups, government digital health teams, and academic institutions; ten semi-structured key informant interviews with stakeholders (n=10) engaged in ABDM- or FHIR-related implementation; desk research covering ABDM, NHCX, NRCeS implementation guides, global HL7 resources, and international FHIR practice; and structured field validation with early implementers. Findings were analysed descriptively and thematically, triangulated across data sources, and interpreted against selected international FHIR ecosystems, including the United States, United Kingdom, Australia, Singapore, and Israel.Results: India has established a mandate-driven national foundation for FHIR-aligned health information exchange through ABDM and NHCX, including national implementation guides based on FHIR R4, sandbox environments, and a growing ecosystem of ABDM-certified vendors. However, adoption across the wider ecosystem remains uneven and largely compliance-driven. Most participating organisations self-positioned at exploration or limited-pilot stages, while national programmes and a small number of larger vendors reported sustained operational use. Lack of funding or business incentives appeared among the top three adoption barriers for nearly two-thirds of survey respondents. Twenty-one barriers were identified across institutional, technical, and operational domains, including weak incentives, fragmented and rigid governance, limited validator and tooling infrastructure, terminology gaps, workforce constraints, and confusion between ABDM compliance and broader FHIR conformance.Conclusion: India has moved beyond formal standards adoption in selected national programmes, but ecosystem-wide implementation remains at an early stage. The central challenge is ecosystem-wide adoption — moving beyond compliance within national programmes so that implementers can validate, trust, and use FHIR as shared infrastructure (i.e., institutionalising it beyond mandate). Priorities include participatory governance, a layered, openly governed IG model — with the India Core as a recommended (not mandated) baseline, complemented by domain and programme/network layers, public validator and sandbox infrastructure, terminology services, procurement and reimbursement incentives, focused high-value public-sector use cases, and sustained workforce development. India’s experience offers lessons for other large, federated, and resource-diverse health systems seeking to scale standards-based interoperability.

Abstract: Introduction: HL7 Fast Healthcare Interoperability Resources (FHIR) has become a leading global standard for health information exchange and is increasingly central to national digital health architecture. Sri Lanka has formally adopted HL7 FHIR Release 4 as its preferred national interoperability standard and has developed national implementation guides, governance mechanisms, and connectathon-based testing activities. However, the operational maturity of FHIR adoption across Sri Lanka’s health system has not previously been systematically assessed.Methods: A mixed-methods baseline assessment was conducted between September and November 2025, using a desk review, rapid literature review, technical review of national FHIR Implementation Guides, semi-structured key informant interviews (n=18), stakeholder surveys (n=16; response rate 88.9%), and interoperability maturity assessments. Interoperability maturity was assessed using the HL7 FHIR Maturity Model (FMM) and the MEASURE Health Information Systems Interoperability Maturity Toolkit. Qualitative data were analysed thematically, and candidate barriers and recommendations were validated with stakeholders using the Nominal Group Technique with Likert-scale scoring. Findings were triangulated across data sources.Results: Sri Lanka has established key foundations for standards-based interoperability, including national FHIR implementation guides, dedicated governance structures, national FHIR Connectathons, and pilot implementations that demonstrate FHIR-enabled data exchange. However, national FHIR artefacts remain at FMM Level 1, with profiles tested against only 37.5% of core data elements, which is below the 80% threshold required for FMM Level 2, while overall interoperability maturity was assessed as nascent (Level 1) across leadership and governance, human resources, and technology domains. Twenty-one barriers to adoption were identified, including limited workforce capacity, lack of national testing infrastructure, insufficient vendor incentives, fragmented governance, donor-dependent financing, and absence of procurement mandates for FHIR compliance. A phased roadmap and a multi-tier national FHIR governance model were derived to guide scaling.Conclusion: Sri Lanka has moved beyond policy endorsement of FHIR and has demonstrated early technical feasibility, but ecosystem-wide implementation remains nascent. The main challenge is no longer the selection of standards alone, but their institutionalization through sustained governance, financing, workforce development, conformance testing, procurement alignment, and regulatory mechanisms. The findings provide a baseline for Sri Lanka and offer transferable lessons for other low- and middle-income countries seeking to scale standards-based interoperability.

Abstract: Volunteering is recommended as a way for older adults to age healthily due to a variety of biopsychosocial health benefits. There are a range of previously identified enablers and barriers to volunteering participation that have been identified. Policymakers may benefit from knowing which strategies are likely to have the greatest immediate impact on recruitment and retention. This study aimed to prioritise enablers and barriers to volunteering and to compare priorities across four participant groups: Volunteer Pro-gram Representatives, Current volunteers, Former volunteers and Never volunteers. Participants (n=681) completed an online survey scoring enablers and barriers to volunteering using Likert scale responses to indicate the importance of each item to commencement and continuation in volunteering. Data were analysed descriptively for responses to each item for each participant group and simple pairwise comparisons were conducted between groups. Feeling welcome scored the highest for all participant groups (Participant Group (Mean, SD): Representatives (4.86, 0.56); Current (4.70, 0.72); Former (4.25, 1.22); Never 4.57 (0.83). Former volunteers valued four items higher than Current volunteers: reim-bursement vouchers, reliable transport, information technology training and online volunteering. Representatives largely scored items higher than Former and Never vol-unteers. Increasing engagement in older adult volunteering requires targeted strategies due to differences in priorities of potential volunteers. Policymakers should consider these community priorities when assessing current volunteering recruitment strategies and to inform future decision-making for funding and resource allocation.

Abstract: Background: Psychiatric advance directives (PADs) are essential for upholding human rights, improving access to mental health care, and ultimately achieving universal health coverage. Despite an emerging body of research, there is no prior synthesis that sought to map the evidence on the roles of PADs in addressing mental health disparities in Africa. Methods: A scoping review was conducted according to Arksey and O’Malley’s framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) reporting standards. Results: 27 publications published between 2008 and 2026 met the inclusion criteria. The following thematic domains emerged; (1) mental health disparities associated with advance directives; (2) mental health acts and legislation that do not align with PADs; (3) barriers to implementation of PADs; (4) the need for advance directives to align with African values; (5) recommendations for improvement. Conclusions: There is a paucity of studies that address the role of psychiatric advance directives in addressing mental health disparities in the African region indicate the main conclusions or interpretations. The review also highlighted that most of the current mental health acts do not promote human rights in their approach and are archaic.

Abstract: This paper proposes an implementation framework for the effective linkage and integration of forest welfare services within the social service system. Focus group interviews (FGIs) and in-depth interviews (IDIs) were conducted with experts in social and forest welfare, and key components were identified through thematic analysis. The findings identified socially isolated youths, middle-aged adults, and social workers as the primary target groups. Limited accessibility is a central challenge for socially isolated youth, necessitating a phased engagement approach. Middle-aged adults demonstrated a strong need for psychological recovery and social participation, yet faced constraints related to time, cost, and accessibility, underscoring the importance of community-based delivery. Social workers were identified as being at a high risk of burnout, and forest welfare services were recognized as potential preventive and complementary interventions. Based on these findings, an implementation framework comprising three core entities—support, delivery, and supply— was structured across four dimensions: user characteristics, delivery systems, service operations, and policy environments. The key conditions for effective integration include institutional foundations, accessibility enhancement, interagency collaboration, and expansion of the private service base. This study explores the potential for forest welfare services to evolve into sustainable components of the public social service system. Future research should empirically examine the causal mechanisms underlying associated health and social outcomes.

Abstract: The increasing use of online review platforms has transformed how patients evaluate and select healthcare providers. Negative online reviews provide valuable insights into patient experiences and sources of dissatisfaction; however, the available evidence remains fragmented across healthcare and dental settings. This scoping review aimed to map the existing literature on negative patient reviews published on online platforms and to identify the main factors associated with patient dissatisfaction in healthcare and dentistry. A literature search was conducted in PubMed, Scopus, and Google Scholar for studies published between January 2015 and October 2025. Studies analyzing pa-tient-authored negative reviews from publicly accessible online platforms, including Google Reviews, Yelp, and Healthgrades, were eligible for inclusion. Data was extracted and synthesized using a thematic approach to identify recurring complaint categories and patterns across settings. Twenty-two studies met the inclusion criteria. The findings showed that negative reviews were predominantly associated with non-clinical aspects of care. The most frequently reported complaints concerned poor communication, un-professional staff behavior, long waiting times, administrative inefficiencies, and financial issues, including perceived high costs and limited pricing transparency. Complaints directly related to clinical quality, treatment outcomes, or pain, were reported less fre-quently. In dental settings, additional concerns were associated with aesthetic outcomes and perceived value for money. The available evidence suggests that patient dissatisfac-tion expressed through online reviews is primarily driven by interpersonal and organi-zational factors rather than clinical performance. Online reviews represent an important source of real-world patient feedback and may support quality improvement initiatives aimed at enhancing patient-centered care.

Abstract: Purpose: Sustaining high-functioning interprofessional teamwork in intensive care settings is essential for patient safety, workforce well-being, and reliable care delivery. However, evidence regarding the role of structured team-training interventions in already high-performing critical care teams remains limited. The purpose of this study was to assess the impact of the Team Training and Clinical Excellence Academy (TTrACE), a structured interprofessional team training program, on collaboration, psychological safety, need satisfaction, and team effectiveness in a critical care setting. Methods: We conducted a prospective pre-post evaluation of an interprofessional critical care team-training program in a medical/surgical ICU at a large academic hospital. The evaluation used previously published measures of collaborative environments and psychological need satisfaction, along with exploratory team-functioning items assessing shared mental models, psychological safety and communication, and perceived team effectiveness. Results: Of the 35 TTrACE enrollees, 28 (80%) consented to participate in the evaluation study. Baseline scores across collaboration, psychological need satisfaction, and team functioning were high and remained stable at one-month follow-up, suggesting preservation of strong team functioning over time. Descriptive improvements were observed in perceived teamness and shared mental models. Most respondents reported having an opportunity to implement TTrACE learnings in practice (11/13, 84.6%; 1 missing response). All respondents who answered the recommendation item indicated they were likely or very likely to recommend TTrACE to colleagues. Conclusions: In high-performing critical care environments, structured interprofessional training may contribute less to large measurable performance gains and more to reinforcing and sustaining relational, communicative, and psychological processes essential for safe patient care. These findings suggest that TTrACE may support the maintenance of high-functioning team environments in critical care, while future longitudinal and comparative studies are needed to examine longer-term impacts on team functioning, workforce well-being, and patient safety outcomes.

Abstract: Background: Access to home- and community-based rehabilitation (HCBR) remains limited for older adults with disabilities in rural settings, particularly in Appalachian regions where intersecting social, structural, and geographic barriers persist. Translating complex, multi-source evidence into actionable tools is critical to support context-sensitive intervention design.Objective: To develop evidence-informed user personas representing older adults with disabilities in rural Appalachia and to illustrate interacting barriers to HCBR access, while advancing a transparent methodology for persona development.Methods: This mixed-methods study employed an integrated, multi-layer analytic approach combining multi-source data extraction from literature, population-level datasets, related personas, and qualitative interviews with older adults with disabilities in the region. These data were synthesized using an integrative framework approach guided by Andersen’s Behavioral Model of Health Services Use, enabling translation into persona attributes and narratives. Stakeholder feedback was used to refine personas and enhance contextual relevance. Explicit linkage between source data, synthesized findings, and persona characteristics supported transparency and reproducibility.Results: Four distinct, evidence-informed personas were developed, structured around functional profiles and caregiving contexts, including neurological, musculoskeletal, and multimorbidity-related disability, as well as a dementia caregiver profile. These personas capture heterogeneous and intersecting barriers to HCBR access, including transportation limitations, digital connectivity challenges, and socioeconomic constraints, alongside individual-level goals, narratives, challenges, and actionable insights. Embedding these multidimensional factors into user-centered empathy-driven representations might support stakeholder understanding, prioritization, and context-sensitive intervention design.Conclusions: This study demonstrates a structured, multi-source approach to persona development that integrates knowledge synthesis, population-level indicators, and qualitative insights into user-centered representations. The resulting personas provide a practical foundation for stakeholder-engaged strategies to improve equitable access to rehabilitation services in underserved rural populations.

Abstract: Background/Objectives: Breast milk transfers living maternal cells and epigenetic regulators, including microRNAs (miRNAs), into the nursing infant, creating biological bonds that extend beyond nutrition. For Muslim communities, this has underappreciated implications, as Islamic law establishes milk kinship (raḍāʿ), a legally recognised familial bond formed through breastfeeding that prohibits marriage between milk siblings. Contemporary human milk banking, however, relies on anonymised donor milk that makes milk kinship traceability impossible for Muslim families. Methods: A narrative review of the biomedical literature on cellular microchimerism and epigenetic transfer via breastfeeding was conducted, alongside review of primary Islamic legal sources and classical and contemporary scholarship on raḍāʿ. Results: Breastfeeding transfers stem cells, immune cells, and miRNA-carrying exosomes from the nursing woman into multiple infant tissues, where they integrate and induce persistent changes in gene expression. Children nursed by the same woman share these biological inputs and may thereby exhibit cellular and epigenetic similarities that partially mirror consanguinity. A substantial body of evidence links consanguineous marriage to a doubling of congenital anomaly risk, a 20-fold increase in rare autosomal recessive disease, elevated infant mortality, and increased intellectual disability. The Islamic prohibition of marriage between milk siblings therefore serves a biologically coherent public health function analogous to, and scientifically consistent with, the prohibition of blood-relative marriage. Importantly, anonymised milk banking creates unresolvable uncertainty about milk kinship ties for Muslim families. Conclusions: The biological evidence for a substantive breastfeeding bond is stronger than commonly appreciated and is directly relevant to Muslim religious obligations. The Islamic prohibition of marriage between milk siblings is biologically coherent — milk siblings share cellular and epigenetic material in ways that parallel consanguinity, which carries well-documented health risks for offspring. Traceability frameworks in milk banking offer a clinically and ethically workable path forward. We provide specific recommendations for researchers, neonatal clinicians, milk bank administrators, and Islamic scholars in this regard.

Abstract: Understanding variations in hospitals’ operational performance and patient safety is critical for improving health system efficiency, particularly in decentralized healthcare systems such as that of Indonesia. While geographic disparities in health outcomes are often emphasized in research, the relative contribution of spatial patterns remains underexplored. Addressing this gap, this study analyzed data from 428 hospitals in East Java, Indonesia. Composite indices were developed to measure hospitals’ operational performance and patient safety outcomes using standardized indicators. Spatial autocorrelation was assessed using global and local Moran’s I at both hospital and district scales. The findings reveal no significant spatial clustering at the hospital level for either operational performance or patient safety outcomes. However, significant spatial clustering of patient safety outcomes emerged at the district level. Finally, the findings of local Moran’s I revealed the specific districts with high and low mortality rates. For policymakers, the implications are clear. Districts revealed as high mortality regions need to receive additional attention immediately. For example, best practices could be learned from districts where low mortality prevails.

Abstract: Dementia is a major global public health challenge, with a substantial proportion of risk attributed to potentially modifiable factors across the life course. Despite this, public understanding of dementia prevention remains limited and is often characterised by misconceptions regarding causation, inevitability, and controllability. Dementia is frequently perceived as a normal consequence of ageing, while awareness of modifiable risk factors is uneven across cardiovascular, metabolic, psychosocial, and environmental domains. This conceptual review synthesises literature from dementia literacy research, health literacy theory, behavioural science, and implementation science to examine the persistent gap between epidemiological evidence and public understanding. It argues that this gap cannot be explained by information deficits alone, but instead reflects the interpretive processes through which biomedical evidence is filtered through pre-existing mental models, health literacy capacities, behavioural appraisals, and structural conditions. Building on this synthesis, the paper proposes the Dementia Prevention Literacy Translation Framework (DPLTF), which conceptualises dementia prevention literacy as a multi-level, dynamic translation process linking biomedical evidence, public mental models, health literacy processes, behavioural appraisal, and preventive action. Rather than a linear pathway, the framework emphasises reciprocal interactions and feedback loops across these levels, alongside cross-cutting structural and environmental influences that shape opportunities for interpretation and action. The DPLTF is presented as an interpretive conceptual model rather than a predictive theory. Its central contribution is to position public interpretive mental models as a key mediating mechanism in the translation of epidemiological evidence into behavioural engagement. The framework highlights why increases in awareness alone are unlikely to produce sustained behavioural change without addressing how individuals understand, evaluate, and integrate dementia risk information within their social and structural contexts. Ultimately, bridging the gap between evidence and action requires multi-level interventions that extend beyond awareness-raising to strengthen interpretive capacity, support integrated understandings of dementia risk, enhance perceived behavioural control, and address structural barriers to prevention.

Abstract: Australia’s Aboriginal Community Controlled Health Organizations are under-resourced and too few. As a result, older Aboriginal and Torres Strait Islander peoples needing dementia-related care frequently receive services from mainstream organizations and non-Indigenous care providers unfamiliar with or unsure about providing culturally safe care. This paper presents reflections of Aboriginal Elders following their initial visit to a rural mainstream residential care community in Trouwerner/Lutruwita (Tasmania) prior to initiating an innovative series of podcasts and vodcasts focused on culturally safe care. Elders spent two days to appreciate and learn about the area and then two days at the residential care community, beginning with a Smoking Ceremony. Elders yarned with staff, individually and in small groups, moving freely about the center. Elders then met to yarn and de-brief. Thematic analysis identified both positive and challenging issues. Six themes were identified: (1) Importance of truth telling, (2) Value of staff interest, (3) Impact of the Smoking Ceremony, (4) Appreciation of the care environment; (5) Lack of Acknowledgement and understanding, and (6) Contribution of an Elder-in-Residence program. Elders’ initial experiences and reflections provided valuable insight into the need for their project and important baseline data from which to measure its impact.

Abstract:

Objective: To examine changes in functional status, mental health, and quality of life among older adults participating in the CEDIAM program in the Maule Region of Chile in 2022 and 2023. Methods: Pre-post observational study using routinely collected data from 15 CEDIAM centers. The 2022 and 2023 datasets were analyzed as independent cohorts. Functional status was assessed with the Barthel Index (BI), Lawton and Brody scale (L&B), and Timed Up and Go test (TUG); mental health with the Mini-Mental State Examination (MMSE) and Geriatric Depression Scale-15 (GDS-15); and quality of life with the EuroQol-5D visual analogue scale (EQ-5D). Paired comparisons, category-transition analyses, and multivariable logistic regression models of improvement were performed. Results: Baseline samples included 894 participants in 2022 and 897 in 2023. In 2022, all continuous outcomes improved significantly (all p≤0.001). In 2023, BI, TUG, GDS-15, and EQ-5D improved (all p<0.01), whereas L&B (p=0.204) and MMSE (p=0.725) did not. Category-transition analyses showed significant improvements in BI and TUG in both cohorts (both p<0.001), while significant categorical changes in L&B, MMSE, GDS-15, and EQ-5D were observed only in 2022 (all p≤0.01). Rural residence was associated with higher odds of BI improvement (OR 1.62, 95% CI 1.17-2.25; p=0.004), whereas age ≥75 years was associated with lower odds of improvement in GDS-15 (OR 0.56, 95% CI 0.41-0.76; p<0.001) and EQ-5D (OR 0.65, 95% CI 0.45-0.94; p=0.023). Conclusion: Participation in CEDIAM was associated with favorable changes, particularly in basic functional status and mobility, although responses varied across outcomes and participant subgroups.

Abstract: Early childhood caries (ECC) remains a common, preventable, and socially patterned disease of childhood. Although the contemporary ECC literature has expanded across nutrition, microbiology, health services, dental rehabilitation, and non-restorative disease management, the field continues to face an important evidentiary challenge: studies that identify associations, describe disease burden, or test caries-arresting interventions are sometimes interpreted as resolving causal questions or providing comprehensive prevention pathways. This critical narrative review examines a representative research trajectory in ECC that has shifted from vitamin D deficiency and nutritional hypotheses to dental rehabilitation under general anesthesia, oral microbiome characterization, and the implementation of silver diamine fluoride. Using a causal-translation framework, we distinguish six evidentiary domains: association, mechanism, causation, consequence, disease control, and policy implementation. Observational studies have repeatedly reported associations between low vitamin D status and ECC, but Mendelian randomization and dose-comparison trial evidence do not currently support vitamin D supplementation as a stand-alone, evidence-based ECC prevention strategy. Research on dental rehabilitation under general anesthesia has demonstrated meaningful improvements in oral health-related quality of life, but such work documents consequences and treatment outcomes rather than disease initiation. Microbiome studies identify dysbiotic patterns in children with severe ECC, yet cross-sectional designs cannot determine whether microbial differences are causes, consequences, or mediators of dietary, fluoride, behavioral, and social exposures. Silver diamine fluoride is evidence-supported for arresting cavitated lesions and can improve access to interim care, but it should not be reframed as definitive care, primary prevention, or a substitute for dental diagnosis and longitudinal treatment planning. The field requires a more explicit causal architecture linking upstream determinants, biological pathways, clinical disease expression, interim stabilization, definitive care, and measurable prevention outcomes.

Abstract: Homeownership is a societal and financial stronghold for people across the world. However, achieving or sustaining homeownership may come with a given cost. This study focuses on financial distress in relation to homeownership and other relevant factors like health. It relies on data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) for citizens of the Nordic and Baltic States aged 50 to 90 years old. The analysis is completed with a logistic (N = 2,878) and ordered logistic (N = 7,030) estimator, which both model the change in the regressed variables from 2020 to 2022. The main findings reveal that homeownership exit alone does not relieve financial distress, yet results in an improvement in combination with a budget-for-food and income improvement. In contrast, a liabilities relief and a change in job situation appear to hinder a financial distress improvement. Overall, the findings can be regarded as relevant for policymakers’ quest for appropriate governmental action to handle citizens’ difficulties with making end meets which arise from sustaining homeownership.