Exposure to per- and poly-fluoroalkyl substances is associated with adverse health outcomes and may generate substantial healthcare and societal costs. This concept study presents an interdisciplinary framework that links epidemiological evidence, health economic modeling, and legal analysis to estimate the health-related costs of PFAS pollution and explore compensation under the polluter pays principle. The framework combines systematic evidence synthesis, pooled effect estimates, and population attributable fractions to quantify the disease burden attributable to PFAS exposure. These estimates are integrated into cost-of-illness analyses to assess preventive and curative healthcare costs, productivity losses, and wider societal impacts. Legal analysis, including hypothetical cases and existing compensation fund mechanisms, is used to examine how quantified health-related costs can inform liability and compensation approaches. By connecting scientific evidence, economic valuation, and legal reasoning, the framework supports evidence-informed policymaking and adaptable compensation mechanisms as knowledge on PFAS-related health effects develops.
It is important that Aboriginal and Torres Strait Islander peoples who experience worries from alcohol use are linked with support. Screening is important to help link people to support. However, individuals may not freely report consumption, especially if they perceive discrimination or drink less than others. Here we report on the use of a 'check question' asking about alcohol consumption on special occasions. We analysed data from an urban and remote community in South Australia, collected between July and October 2019. Participants who self-reported not drinking alcohol were then asked, using a check question, if they had consumed any alcohol, including on special occasions. We explored the link between alcohol consumption and demographics using linear regression models. We used logistic regression to identify differences between individuals who did and did not initially self-report alcohol consumption. A total of 775 Aboriginal and Torres Strait Islander peoples participated. By using a check question, we identified 20 individuals who then self-reported alcohol consumption in the previous 12-months. They reported a median consumption of 5.4 standard drinks per occasion, had a lower AUDIT-1 score and reported more consecutive days not drinking alcohol. A check question in an alcohol survey tool was useful to identify individuals who do occasionally drink alcohol. Improving how screening tools ask about alcohol consumption is important to help people feel more comfortable and understand that the questions also apply to occasional drinking. This could help with collecting accurate data to inform prevention, treatment and policy efforts.
To evaluate the effects of Affordable Care Act (ACA) Medicaid expansions on changes to net (after-tax) income and federal tax liability across socioeconomic status (SES). Event study and difference-in-difference analyses assessed the effects of state-level ACA Medicaid expansions post-2020 on net income and federal tax liability. Analyses were performed on nationally-representative survey data from the 2010 to 2023 Integrated Public Use Microdata Series Current Population Survey (IPUMS CPS) Annual Social and Economic Supplement (ASEC). We restricted the sample to individuals aged 18-65 with known information on sociodemographic characteristics. Medicaid expansions contributed to overall net income growth (2.10%, 95% CI 1.31-2.89). By socioeconomic status, postexpansion net incomes were higher among individuals in the lowest income quintile (3.56%, 1.47-5.65), among those employed in low (4.90%, 2.74-7.07), low-mid (2.05%, 0.57-3.54), and mid-high (1.97%, 0.61-3.32) skill occupations, and among those with less than a high school degree (3.51%, 0.50-6.51), some college (3.39%, 1.47-5.32), or a bachelor's degree (1.94%, 0.32-3.56). Results further show an increase in overall federal tax liability after deductions (3.84%, 2.43-5.25), namely among individuals in the second (5.20%, 0.72-9.68) and third (4.58%, 2.31-6.86) income quintiles, among those in low (6.99%, 2.78-11.20), low-mid (6.82%, 4.05-9.60), and mid-high (2.71%, 0.42-5.01) skill occupations, and among those with a high school degree or GED (4.79%, 1.97-7.60) or a master's degree (7.99%, 3.70-12.28). Findings suggest ACA Medicaid expansions induced downstream net income gains while increasing overall federal tax revenue. Results further suggest that the increased costs of Medicaid expansion are not largely borne by higher SES groups. Broadly, Medicaid expansions may provide substantial economic benefits to the entire U.S.
Education is a well-established determinant of health and well-being, yet its benefits may not be equally distributed across populations. This study examines whether educational attainment predicts psychological well-being, financial difficulty, and social support among deaf adults and whether these associations differ from those observed among hearing adults. Using nationally representative data from the U.S. Household Pulse Survey, we analyzed a weighted sample of adults aged 25-54 (N = 36,810), employing multivariate linear regression models that included education, hearing status, their interaction, and demographic covariates. Higher education was generally associated with more favorable outcomes among deaf adults, particularly in psychological well-being and social and emotional support, though effects were modest and less consistent for financial difficulty. Hearing adults reported significantly better outcomes across all domains, and interaction effects indicated that the benefits of education were significantly larger for hearing adults than for deaf adults. These findings suggest that while education remains beneficial for deaf people, its protective effects are limited, likely due to persistent structural and communication barriers. Given the importance of education, improving access alone will not eliminate disparities in well-being without concurrent efforts to address structural and social inequities.
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Extreme heat is emerging as one of the most consequential occupational hazards of the 21st century. More than 2.4 billion workers, over 70% of the global labour force, are exposed to excessive heat, with more than 22 million heat-related occupational injuries and nearly 19,000 deaths each year. By 2030, heat stress is projected to reduce global working hours by 2.2%, equivalent to 80 million full-time jobs, with the heaviest losses concentrated in low- and lower-middle-income countries. This paper argues that these figures disclose not only a climate and labour crisis, but also a problem of health justice. To conceptualise this, the article develops the framework of 'heat debt' to articulate the physiological, economic, and temporal burdens disproportionately imposed on workers to sustain global production, supply chains, and essential services in a warming world. Synthesising evidence from agriculture, construction, garment manufacturing, informal urban labour, and healthcare, this paper demonstrates that this debt is systematically offloaded onto low-wage, migrant, informal, and feminised workforces. The analysis proceeds in three parts. First, it argues that excessive occupational heat must be analysed through the lenses of distributive and reparative justice. Second, it demonstrates how current labour law, climate policy, and corporate supply chain governance institutionalise thermal inequality. Third, it interrogates health systems in their dual capacity: as primary responders to heat-related morbidity, and as occupational environments that actively reproduce heat vulnerability among clinical staff. The article concludes by advancing a bioethical mandate of 'cooling as care,' positing that occupational thermal protection is an indispensable prerequisite for climate justice, decent work, and ethically defensible healthcare delivery.
Carbon dioxide removal (CDR) is increasingly recognised as necessary to achieve net zero emissions. Enhanced rock weathering (ERW) is a novel CDR approach with large mitigation potential. With undefined social and environmental costs, and evolving economic and governance systems, ERW raises issues for public acceptance. A literature gap exists regarding how local communities view the possibility of at-scale deployment in their area. We address this with data from five UK public workshops to identify conditions under which communities potentially impacted by ERW consider deployment fair and acceptable. We show that public acceptance is conditional upon place-sensitive deployment pathways that reflect how place is valued. Analysis highlights opportunities to minimise risk and maximise benefits experienced locally; the importance of transparent governance and monitoring; and unbiased, balanced communication of impacts. Conversely, our research also reveals conditions that might make deployment unacceptable to local communities, including being ineffective as a CDR, environmental contamination connected to ecosystems, the absence of remediation plans, and mitigation deterrence through false carbon accounting. Understanding and incorporating public perceptions and preferences into emergent governance systems is essential if they are to be fair, effective and representative of societal concerns.
The sexual health of women with gynecological or breast cancer is a major determinant of their quality of life, yet it is largely ignored in oncological care pathways. This systematic review, based on 25 studies conducted in Arab countries among patients aged 18 years and over (undergoing treatment or in remission), reveals a profound alteration in their intimate lives: Decreased desire, lubrication difficulties, orgasmic disorders, sexual dissatisfaction, and infrequent intercourse. These dysfunctions are not solely the result of the physical side effects of treatment, but are the result of a complex intertwining of biological, psychological, relational, sociocultural, and economic factors. In Arab contexts, marked by conservative cultural norms, the silence surrounding sexuality exacerbates these difficulties: patients are reluctant to talk about it with their partners, and healthcare professionals, who are often poorly trained or embarrassed, rarely address this issue. This collective silence hinders the provision of appropriate care. To remedy this, it is imperative to integrate sexual health into oncological care in a structured and culturally sensitive manner. This requires a multidisciplinary approach involving oncologists, psychologists, sexologists, and nurses, as well as therapeutic education programs focused on the real needs of patients. Only such a strategy, which is both holistic and contextualized, will restore not only their sexual well-being, but also their dignity and sense of normality after cancer. RésuméLa santé sexuelle des femmes atteintes d’un cancer gynécologique ou du sein, bien qu’essentielle à leur qualité de vie, reste négligée en oncologie. Cette revue systématique de 25 études menées dans des pays arabes révèle une altération majeure de la vie intime (désir, lubrification, orgasme, satisfaction, fréquence des rapports). Ces dysfonctions résultent d’une intrication de facteurs biologiques, psychologiques, relationnels et socioculturels. Dans un contexte marqué par des normes conservatrices, le silence entourant la sexualité et le manque de formation des soignants entravent le dialogue et la prise en charge. Une intégration structurée, multidisciplinaire et culturellement adaptée de la santé sexuelle dans le parcours oncologique, accompagnée d’une éducation thérapeutique ciblée, est indispensable pour restaurer le bien-être et la dignité des patientes.
Housing eviction is interrelated with alcohol consumption and harms that are fully and partially attributable to alcohol. For populations experiencing an increased risk of both eviction and alcohol-related harms, understanding community resiliencies that protect against both issues could reveal key intervention opportunities. We recruited adults (n = 16) from Allegheny County, PA with lived experiences of eviction/eviction threat and regular alcohol use (ages 24-59, 68.8% identified as Black, 68.8% as female, 93.8% as heterosexual). Through semi-structured baseline interviews and follow-up photo elicitation interviews, participants discussed and photographed assets in their neighborhood and living environments that prevented or reduced the negative impacts of alcohol and/or eviction. We analyzed data from interviews using thematic analysis. Challenges discussed by participants included eviction threat and post-eviction housing insecurity, drinking to cope with eviction-related stress, and alcohol-related harms and problems, which included eviction. Assets that protected against challenges related to both alcohol and eviction included social support, legal and financial assistance for housing, access (including transportation) to employment that pays a living wage, access to green space, opportunities to exercise, and community spaces. Community spaces increased access to other assets by facilitating social ties, resource dissemination, and activities to help cope with eviction-related stress. Improving community resources and spaces could reduce the impacts of eviction and alcohol-related harms. Strategies that address housing insecurity in conjunction with other social determinants of health may reduce the burden of alcohol and eviction.
Coumarin is a versatile heterocyclic compound with wide applications in the fields of medicines, sensors, fluorescence probes, optoelectronics, and photovoltaics. Coumarin shows fluorescence in the visible region and suitable substitutions with various chromophores make it tunable for applications in the latest (third) generation of solar cells. Dye-sensitized solar cells have profited well with attractive coumarin-based photosensitizers via the various structural frameworks of coumarin, namely D-A, D-π-A, D-D-π-A, and D-A-π-A. The functionalization of coumarin dyes as donors with appropriate fullerene or fullerene-free acceptors is significantly utilized for both binary and ternary blends in bulk heterojunction organic solar cells. This review article pays particular focus to the design, synthesis, and photovoltaic analysis of various coumarin dyes for fabrication in both DSSCs (dye-sensitized solar cells) and OSCs (organic solar cells), reported since 2014.
This paper brings insights from classical Indic, Tantric, Daoist, and Hellenistic medical traditions into dialogue with contemporary developmental science to examine the metaphysical, relational, and moral status of the embryo during its formation. Modern embryology provides detailed scientific explanations of genetic, epigenetic, and physiological development. However, it pays comparatively less attention to how embodied life emerges and to the philosophical significance of early embryonic development. The study adopts a comparative health humanities approach to examine how concepts such as garbha, prāṇa, qì, pneuma, developmental plasticity, and maternal-fetal relationality reflects different cultural and philosophical understandings of embryological formation. Rather than treating classical traditions as precursors of modern biology, the analysis identifies both convergences and divergences in how these traditions conceptualize vitality, embodiment, temporality, and developmental continuity. Across these traditions, embryological development is understood not as the unfolding of a pre-existing essence but as the progressive organization of embodied life through interacting physiological, environmental, temporal, and relational conditions. The comparison reveals both shared insights and important differences among these traditions. Although concepts such as prāṇa, qì, and pneuma describe aspects of formative life, they should not be reduced to modern biological categories. By bringing these perspectives into dialogue, the paper shows how comparative health humanities can broaden contemporary understandings of development, embodiment, vulnerability, and care while respecting the historical context of each tradition.
South Korea's healthcare system is based on the National Health Insurance (NHI), and private insurance is commonly purchased to cover services not fully reimbursed by the NHI. Rising medical expenditures associated with indemnity-type private health insurance have become a growing policy concern. In this cross-sectional study, adults aged <65 years without chronic diseases were selected from the Korea Health Panel Survey (2019-2020). Participants were classified into fixed-benefit or indemnity private insurance groups. Healthcare utilization and expenditures were compared, and multivariable regression models were used to evaluate factors associated with medical use and visit frequency. A total of 3,320 participants were included in the analysis. The indemnity group showed higher outpatient care use than the fixed-benefit group, with mean outpatient visits of 9.14 versus 7.46 per year. There were no significant differences in expenditures for emergency or inpatient services. In the multivariable analysis, indemnity insurance was associated with higher outpatient care use (adjusted OR, 1.503; 95% CI, 1.232-1.834) and a higher number of outpatient visits (adjusted IRR, 1.167; 95% CI, 1.069-1.274). These findings suggest that indemnity-type private insurance is associated mainly with greater outpatient healthcare utilization and outpatient expenditures among adults without chronic diseases. The findings should be interpreted as outpatient-focused associations rather than evidence of broader system-wide cost effects. South Korea has a universal National Health Insurance (NHI) system, but many people also purchase private health insurance to cover additional medical costs. Two common types exist: fixed-benefit insurance, which pays a set amount regardless of actual costs (for example, a fixed sum upon hospitalization), and indemnity insurance, which reimburses what you actually paid out of pocket. Using data from the Korea Health Panel Survey, this study examined whether the type of private insurance was linked to how often people used healthcare services. We focused on adults under 65 years of age without chronic diseases. People with indemnity insurance visited outpatient clinics (such as hospital or clinic visits that do not require an overnight stay) more often and spent more on outpatient care than those with fixed-benefit insurance. However, no meaningful differences were found in emergency room visits or hospital admission costs between the two groups. These findings suggest that indemnity insurance is mainly linked to more frequent outpatient visits, rather than a broad increase in all types of medical care. Further research is needed to understand whether these differences persist over time and how the design of private insurance may influence the way people seek and use healthcare.
Our understanding of trypsin, its zymogenicity and its inhibition is intimately intertwined with the history of biochemistry. Early structural studies revealed its close relationship to chymotrypsin, with its active site triad, oxyanion hole and N-terminus involved in a buried salt bridge near the active site. Its complex with basic pancreatic trypsin inhibitor provided a model for how peptide substrates bind to and are cleaved by the proteinase. Analysis of crystals of trypsinogen by Wolfram Bode and Robert Huber revealed that a large region of the zymogen is disordered prior to proteolytic activation, with an associated disruption of the oxyanion hole and substrate binding pockets, highlighting the importance of disorder in protein function. As archetype of numerous therapeutically important serine proteinases, trypsin can also serve as a surrogate for structure-based drug design. Trypsin variants designed for ligand binding studies resulted however in an unexpected plasticity of the mutant proteins that underlines the complexity of protein stability. A trypsin variant selected for peptide ligation (reverse proteolysis) was shown to possess zymogen-like characteristics that proved central to its application in modification of therapeutic proteins. The review pays homage to the seminal works of Bode and Huber and their influence on modern structural biology.
The literature pays little attention to the impact of gratifications on fake news sharing among Chinese social media users, and fuzzy-set qualitative comparative analysis (fsQCA) is rarely used in fake news research. This study investigated the relationship between gratifications and fake news sharing among Chinese users. Study 1 employed partial least squares structural equation modeling (PLS-SEM) and fsQCA on the questionnaire data from 315 participants. Study 2 analyzed predictions of self-reported sharing intentions in task scenarios using data from 98 new participants. The PLS-SEM revealed that instant news sharing was positively predicted by time-passing, entertainment, and socializing gratifications; and negatively predicted by information seeking. Fake news sharing is positively predicted by instant news sharing and negatively predicted by fact-checking. The fsQCA revealed three distinct antecedent configurations leading to high sharing among users, demonstrating that sharing is driven by diverse, equifinal pathways rather than a single set of common characteristics. Study 2 confirmed that self-reported sharing intention predicts sharing intention in task scenarios. Gratifications influence users' fake news sharing through instant sharing and fact-checking, and three configurations prompt users to share fake news. These findings promote the cultural richness of the fake news-sharing research and offer practical implications.
New Zealand's 2001 Primary Health Care Strategy set a bold goal of reducing health inequities through a population health approach with innovative models of care and a revised funding framework. Twenty-five years later, significant disparities persist. This paper utilises recent literature alongside a case study derived from a recent evaluation of a long-term conditions programme in primary care. The evaluation found significant barriers to a successful model of care. These included a generic user-pays model that did not accommodate low health literacy, poverty-related constraints, geographic isolation, disability or the need for culturally safe care. System-level obstacles such as complex referral pathways, inadequate training, insufficient resourcing and static funding mechanisms further entrenched inequity. The article concludes that persistent inequities for some groups in Aotearoa New Zealand demonstrate that innovative programmes alone cannot overcome structural, resourcing and policy deficits. A fundamental reorientation of primary healthcare funding and design that integrates socio-economic, cultural, environmental, commercial, digital and geographical determinants is required. Embedding cultural safety to honour the diversity in our communities, along with an appropriate allocation of resources for primary healthcare in both rural and urban settings, is necessary to work towards equitable health outcomes in Aotearoa New Zealand.
Patients with gastric cancer in the peri-operative period often face a high risk of malnutrition, which is closely related to poor prognosis. Currently, clinical practice pays insufficient attention to this issue. The existing evidence suggests that improving the quality of nutritional screening, assessment, and management can significantly reduce the incidence of malnutrition and its related adverse outcomes. This project aimed to implement evidence-based practices to improve the quality of nutritional screening, assessment, and management of peri-operative gastric cancer patients in a tertiary hospital in central China. This project was guided by the JBI Evidence Implementation Framework and used the JBI PACES tool to establish six review criteria for the baseline and follow-up audits. The CFIR framework was used to identify barrier factors, and the CFIR-ERIC implementation strategy matching tool was used to develop targeted strategies. Meanwhile, the GRiP method was used to organize resources and develop improvement plans. To assess the compliance of baseline and follow-up audits with best practices, this study used nursing records, medical records, and direct patient interviews as data sources. The project led to substantial improvements in evidence-based nutritional practices. Compliance with regular nutrition screening increased from 9.4% to 96.9%, while peri-operative nutritional support rose from 6.3% to 96.9%. Additionally, the use of a validated nutrition assessment tool, quantitative nutritional evaluation, and individualized dietary support before and after surgery improved from 0% to 87.5%. Notably, the use of a validated nutrition screening tool consistently achieved a 100% compliance rate. This evidence-based practice project improved health care professionals' compliance with best practices for nutritional screening, assessment, and management of peri-operative gastric cancer patients. http://links.lww.com/IJEBH/A656.
French pediatric orthopedics has profoundly influenced global surgery through its approach based on an understanding of growth, biomechanical rigor, and the pursuit of simple, safe, and teachable techniques. On the occasion of the SOFCOT centenary, the SOFOP board pays tribute to these innovations that have become international references. The French school distinguished itself by first seeking to measure in order to treat better, with Duval-Beaupère's work on the evolution of scoliosis, Hechard and Carlioz's growth tables, Mallet's functional score for obstetric palsy, and Diméglio's classification for clubfoot. It also initiated major technical advances such as low-dose biplanar radiography, opening the way for precise 3D imaging. Innovation was also grounded in using growth as an ally: Métaizeau's percutaneous epiphysiodesis, Bollini's physeal distraction, or Bérard's screw for slipped capital femoral epiphysis. Similarly, the management of congenital hip dislocation and Legg-Calvé-Perthes disease demonstrates a balance between correction and biological preservation. In traumatology, France set universal standards: Elastic Stable Intramedullary Nailing (Métaizeau, Ligier, Lascombes), Judet's percutaneous pinning for supracondylar humeral fractures, and Bouyala's technique for neglected Monteggia lesions. In spinal surgery, the major contributions of Cotrel and Dubousset, the Stagnara wake-up test, the concept of sagittal balance, and the use of sublaminar bands redefined three-dimensional scoliosis correction. Finally, advances in functional reconstruction (Gilbert, Carlioz, Oberlin) and biological reconstruction (Masquelet) extend this pursuit of efficacy and humanity. This legacy reminds us that innovation in pediatric orthopedics is born from careful observation of the child, respect for growth, and the sharing of knowledge-to accompany the child toward adulthood. Level of evidence: V; narrative review.
Introduction This study investigates whether recombinant human bone morphogenetic protein-2 (rhBMP-2), once dissociated from its carrier (absorbable collagen sponge (ACS)) and transported as a soluble factor, retains sufficient osteoinductive capacity to induce ectopic bone formation. Methods ACSs were loaded with rhBMP-2 (1.5 mg/mL) and centrifuged at 500 rcf to generate supernatant run-off (SRO) containing dissociated rhBMP-2. The concentration of rhBMP-2 in the SRO was quantified by UV spectrophotometry (n = 9). In a paired design, 10 athymic nude rats received intermuscular implantation of the centrifuged ACS in the right hindlimb and injection of the corresponding SRO into the contralateral left hindlimb. At 28 days, implant sites were evaluated by micro-CT for bone volume (BV), tissue volume (TV), bone volume fraction (BV/TV), and bone mineral density (BMD), followed by histological assessment. Results In vitro quantification determined that centrifugation released an average of 11.3% ± 6% of the rhBMP-2 load into the SRO. In vivo micro-CT analysis at 28 days demonstrated mineralised tissue formation at both sites. The SRO group exhibited significantly lower total tissue volume than the ACS group (8.05 mm³ vs 29.4 mm³, P < 0.05). No statistically significant differences in bone volume fraction (BV/TV) or bone mineral density (BMD) were detected between groups. Histological evaluation confirmed that mineralised tissue variably represented bone, with the SRO group showing a spectrum from mineralised cartilage to woven bone to corticocancellous-like architecture. The ACS group demonstrated more consistent bone formation but with greater heterogeneity in maturation, including cystic and adipose-dominant phenotypes in some animals. No correlation was observed between the volume of SRO administered and the resulting mineralised tissue volume. Conclusions rhBMP-2 that dissociates from its delivery scaffold retains osteoinductive potential and can induce mineralised tissue when transported as a soluble factor. Histologically, this mineralisation ranged from mineralised cartilage to mature bone. Since clinical burst release substantially exceeds the 11% tested here, these findings represent a conservative estimate of the clinical risk. Liberated rhBMP-2, even in small quantities, may contribute to off-target mineralisation, which could be clinically relevant if formed adjacent to neural elements. These findings emphasise the need for improved controlled-release delivery strategies.
Hydrologic droughts are intensifying globally due to climate change and human water demand. Although a myriad of drought impacts on river ecosystems have been described, manipulative experiments on the topic have often yielded inconclusive or inconsistent results. Here, we investigated to what extent this inconsistency could be due to uncontrolled variation in methodological choices, or to variation in how different ecological endpoints respond to drought. To this end, we developed a meta-analysis of 1284 effect sizes from 53 experiments, and estimated drought impacts on key variables of riverine biodiversity and ecosystem functioning. We evaluated study design (e.g., temporal vs. spatial focus, controls, treatment characteristics), focal ecosystem endpoint and variable type (i.e., quantity, structure, function), and level of biological organization studied. We found that methodological features strongly influenced the detectability and magnitude of the estimated drought effects, with Before-After-Control-Impact (BACI) designs reporting 2× stronger impacts than simpler designs. Effects differed among measures of quantity, structure, and function; and across ecosystem endpoints, with sensitivity to drought generally increasing with trophic position. Finally, for BACI designs, responses tended to be 1.5× weaker at higher levels of organization (ecosystem) relative to lower levels (population), suggesting an important role of compensatory dynamics and functional redundancy in absorbing drought impacts. Our findings confirm that drought degrades river ecosystem structure and functioning, but effect detectability and magnitude strongly depend on experimental choices and ecological focus. Although studies with replication over space and time (e.g., BACI) require more effort, we show that they are uniquely powerful in parsing out true drought effects from confounding effects of other time-varying processes. We contend that embracing robust experimental designs that include spatio-temporal controls and multiple levels of organization would vastly improve our ability to forecast ecological consequences of global change in river ecosystems.