Objectives. To apply human-centered design (HCD) for creating a new systems alignment model that addresses upstream barriers to newcomer health and well-being. Methods. We leveraged an existing federal mechanism for coordinating regional newcomer resettlement in the United States known as quarterly consultations (QCs). We partnered with a 6-member advisory panel and applied HCD methods across 3 iterative phases: inspiration, ideation, and implementation. We conducted formative research including QC meeting observations, a focus group, and key informant interviews. The project team channeled research insights to design the prototype of a new alignment model. Results. HCD deepened our understanding of QCs, system partner experiences, and structural barriers experienced by newcomers, to inform the design of a new alignment structure, process, and activities anchored in system mapping. Conclusions. HCD methods can help design effective and efficient operations, programs, and policies that are suited to the realities of diverse system partners and the people they serve. More effective systems alignment for resettlement efforts serving newcomers can reduce duplication of efforts, balance capacity shortages, and sustain collective impacts, to potentially benefit other community groups experiencing similar structural barriers to health and well-being. (Am J Public Health. 2026;116(S3): S143-S151. https://doi.org/10.2105/AJPH.2026.308611).

Good communication is imperative to high-quality patient care, particularly for achieving positive outcomes in healthcare consultations. Evidence about communication in clinical consultations for people with motor neurone disease (MND) is limited, but the knowledge gap prevents possible improvements to communication skills that are unique to the challenges that people living with MND encounter. This research aims to better understand and improve communication experiences for patients with MND. A 24-month qualitative longitudinal study whereby data collection will explore 10-15 cases of persons living with MND. For each case, we will recruit one patient, one close person/carer and one healthcare professional for separate interviews alongside an observed clinical consultation. The patient will be interviewed three times at approximately 4-6-month intervals over 12 months to explore the changing experiences, communication challenges and impact on quality of life. Close persons and healthcare professionals will be interviewed once. Data will be analysed to draw out patterns within and between cases, incorporating thematic analysis, corpus linguistics and conversation analysis techniques. Ethical approval was granted by the Health Research Authority (ref: 26/WM/0026).A co-design workshop will develop a framework for an educational toolkit for healthcare professionals to improve communication skills with MND patients. Findings will be disseminated to the academic community, healthcare staff and the public to increase reach and impact (academic journals, seminars, conferences, newsletters, community groups and engagement events). We will make recommendations for improvements to policy and practice. ISRCTN15571034.

Timely detection of pathogen-related outbreaks in hospitals is important for preventing onward transmission and can be supported by automated outbreak detection systems (AODS). Many methods overlook in-hospital patient transfers and focus only on patient locations at the time of sampling. This study compares three approaches for incorporating patient transfers into AODS. Two existing AODS frameworks, a local percentile-based system and a statistical modeling-based system were extended to include patient transfers: 1) grouping wards into communities based on frequent patient exchange, 2) including prior ward visits in the past 14 days, and 3) including both prior ward visits and time spent on wards. Alerts generated were reviewed for clinical relevance. Data from January 2014 to December 2021 from a University Medical Center in the Netherlands. Using the percentile-based approach, the baseline scenario detected 99 possible outbreaks. Extension with ward community groupings, prior ward visits, and prior ward visits accounting for time spent in each ward increased this number with 16 (+15%), 42 (+42%), and 106 (+110%) possible outbreaks, respectively. Of the alerts generated by including individual patient transfer history, 35% were judged as requiring investigation. The trade-off between increased detection and relevance was less favorable for the other approaches. Similar findings were found for statistical modeling-based methods. Inclusion of patient transfer data in AODS improved sensitivity, at the cost of increasing the alert burden. Therefore, ongoing refinement should further optimize the balance between accurate outbreak detection and a manageable alert burden.

The aim of this research is to analyze the determinants of social capital of the Lease Islands Group community as an effort to alleviate poverty in Maluku Province. The problem is focused on the number of poor people in Maluku Province as of September 2021 reached 16.3%. This makes Maluku slump as the 4th poorest province in Indonesia. This problem can hinder the achievement of the objectives of Law of the Republic of Indonesia Number 11 of 2009 concerning Social Welfare. In order to approach this problem, a theoretical reference is used. This research uses qualitative descriptive methods, data collection techniques using interviews, observation and documentation. The results of the research show that there are 2 (two) determinants of social capital in the Lease Islands Group community. Firstly, the Tuahaha bond, namely the bond of cooperation and solidarity based on common origins. Second, kinship networks are referred to as "eyes of the house", so that current poverty alleviation efforts are formulated by utilizing the availability of social capital that exists in community groups as energy or capacity to increase networks.

Background/objectives: To describe and compare Korean AYAs’ and parental perspectives on the family environment in terms of agreement and significant differences and examine which variables were associated with AYAs’ symptom distress. Sample and setting: Self-report data were collected from a total sample of 113 AYAs, recruited from a pediatric-oncology outpatient clinic at a university-affiliated hospital and community group in South Korea. Because each study aim required different data sources, different analytic samples were used. Specifically, 54 AYA–parent dyads were included for Aim 1, whereas self-report data from 111 AYAs with complete data were used for Aim 2. Methods and variables: This subgroup analysis used a quantitative–descriptive, cross-sectional design. AYAs’ and parent perceptions of the family environment (family cohesion and adaptability, family strength, and social support from family) and AYAs’ symptom distress were collected using reliable and validated self-report questionnaires and analyzed using descriptive and inferential statistics. Results: AYAs and their parents showed low (family support) to moderate agreement (family strength, family cohesion, and adaptability) on perceptions of family environment (ICC = 0.374–0.612). AYAs reported significantly lower perceptions of family support than their parents, with a small to moderate effect (p < 0.001, d = 0.48). All family environment variables were correlated with AYAs’ symptom distress (p < 0.05). Among these variables, AYAs’ perceived family strength emerged as the only family environment variable significantly associated with their symptom distress (F = 14.309, p < 0.001, R2 = 0.359, R2adj = 0.334), which was stronger during treatment. Conclusions: AYAs’ perceived family strength should be routinely assessed, especially during cancer treatment. Additional nursing interventions focusing on enhancing AYAs’ families as a support group are needed.

Residual cardiovascular risk persists despite optimal control of traditional risk factors. Ceramide-based lipid scores have emerged as novel biomarkers that may improve prognostic assessment in Cardiovascular Disease (CVD) and Heart Failure (HF). The literature was reviewed using PubMed, Embase, and the Cochrane Library, with all records up to October 2025 included. Terms like ceramide, ceramide ratios, CERT1, CERT2, lipidomics, cardiovascular disease, and heart failure were searched. The focus of the study was on prospective cohort studies, randomized trial substudies, and external validation analyses that linked ceramide-based scores to cardiovascular outcomes. Studies that only used experimental or preclinical models were excluded. If multiple papers came from the same group of patients, the most thorough or reliable ones were selected. Because of differences in how scores were constructed, tested, and reported, the findings were summarized qualitatively rather than conducted as a meta-analysis. Results In several studies, ceramide-based scores were consistently linked to worse cardiovascular outcomes, even after accounting for standard risk factors. CERT2 performed well in both people without heart disease and those with existing conditions. In the STABILITY trial, CERT2 predicted cardiovascular death (HR 1.47, 95% CI 1.35-1.59) and hospitalizations for Heart Failure (HR 1.56, 95% CI 1.39-1.76). Adding ceramide ratios, especially C16:0/C24:0, to existing models improved risk prediction, with net reclassification improvements up to 0.17. On the other hand, higher C24:0/C16:0 ratios were linked to lower risks of death from any cause or from heart disease. These results were similar in older adults, people with diabetes, and community groups. Ceramide-based scores reflect metabolic risks that standard lipid tests do not show. They offer extra information for predicting outcomes in different clinical situations, including heart failure. Ceramide-based lipid scores, especially CERT2 and some ceramide ratios, provide extra value for predicting cardiovascular risk beyond traditional factors. However, most evidence so far only shows associations, not cause and effect, so their use in everyday clinical care is still under investigation. More studies in different groups and randomized trials are needed before these scores can be used regularly in practice.

IntroductionAvoidable and unfair variation in access to palliative care exists for different groups of people and communities. Primary and community care teams deliver most palliative care and care to people at the end of life at home but the quality of care provided is variable. This is an under-researched area and receives little attention in service design and policy. This study will investigate the key contexts, resources and components required for an integrated approach to palliative care to deliver improved and more equitable outcomes for patients and carers.Methods and analysisThis mixed-methods study adopts a realist methodological approach, and comprises four work packages:A multi-perspective mixed-methods study to understand patient preferences and priorities in palliative care, prioritising recruitment of patients and family members/carers from areas of socioeconomic deprivation. Data collection will comprise: (1) qualitative interviews, (2) review of patient case notes and (3) a discrete choice experiment. Realist analysis will result in the development of theory based on the identification of the key contexts and underlying mechanisms required to achieve beneficial outcomes through an integrated approach to palliative care.A realist evaluation of existing integrated models of palliative care will involve theory-refining interviews and theory-consolidating focus groups with professionals working in three different service areas.Dynamic simulation modelling of the healthcare resources needed to deliver the proposed integrated approach, ensuring quality and equity.The theoretical and economic modelling will be tested out at two expert stakeholder workshops to determine the key enablers to implementation in practice.Patient and public involvementThe study design was informed by patient and public involvement (PPI) with 16 patients and members of the public from diverse and socioeconomically deprived communities for 12 months in a National Institute for Health and Care Research-funded palliative care partnership. PPI will be continuous throughout the study, prioritising inclusivity.Ethics and disseminationEthical approval was obtained from the East of Scotland Research Ethics Service Research Ethics Committee 2, on 20 August 2025 (IRAS ID: 354755) and Health Research Authority approval on 1 October 2025. The targeted dissemination strategy will include outputs and resources for key audiences including patients and families, professionals in primary care and specialist palliative care and service commissioners. The results will inform service delivery to reduce inequities and optimise the use of finite resources to maximise impact.Trial registration detailsThe study is registered with the ISRCTN UK Clinical Study Registry: https://www.isrctn.com/ISRCTN61092011.

Intrinsic links between obsessive-compulsive symptoms and other psychopathological symptoms: A network analysis of clinical and community populations.

Opportunities and challenges in community-led action on weather extremes for health and wellbeing.

Addressing community concerns about unregulated organic contaminants in surface water: Integrating suspect and non-targeted chemical analyses with zebrafish toxicity testing and computational hazard comparisons.

ABSTRACT Children with attention difficulties are more susceptible to problematic media use (PMU). However, little consideration has been given to whether the risk of PMU varies based on the nature of attentional difficulties, namely whether children diagnosed with ADHD or difficulties that co-occur with early neurological risk are differentially related to PMU. The Problematic Media Use Measure (PMUM) was examined in three samples of parents with children aged 6–18: Community (N = 386), ADHD (N = 66) and early neurological risk (N = 65) samples, using a mixed-methods approach. Parents were given questionnaires to assess PMU and screen media use and impact, followed by semi-structured interviews with a subset of parents in the ADHD sample. Group comparisons used an age- and sex-matched subset (n = 36/group). Parents in the ADHD group reported higher PMU and more stress related to screen media use compared to both the Early Neurological Risk and Community groups. Parents in the ADHD group also reported significantly more negative and fewer positive impacts of screen media for their children compared to the Community group. Higher PMU was associated with older age in the Early Neurological Risk group (r s = .26, p = .04), and higher externalizing behavior in both clinical samples (ADHD, r s = .29, p = .02; neurological, r s = .56, p < .001). Thematic analysis of parent interviews yielded complementary themes, including unique challenges of screen use for children with ADHD. Clinical implications and future research directions are discussed.

ABSTRACT This study explores how food-based pedagogies foster belonging among Black undergraduate students at a predominantly White institution. Grounded in critical race theory and using a narrative inquiry approach, the study centers the experiences of three first-year Black students who participated in a food justice-themed seminar. Through activities including community cookbook development, food storytelling, and group cooking sessions, participants engaged in practices that affirmed their identities, strengthened community, and challenged experiences of marginalisation. Their narratives demonstrate how food-centered pedagogies can disrupt dominant institutional norms and create spaces of connection, agency, and joy. By examining the intersections of race, food, and pedagogy, this study contributes to scholarship on inclusive teaching and student belonging. The findings suggest that food-based pedagogies offer a meaningful and accessible approach to centering Black student voices and cultivating transformative learning environments, particularly within higher education contexts where equity, inclusion, and belonging remain contested and urgent concerns.

A story trail is an activity that combines exercise and literacy as visitors read sequentially displayed book pages while walking. Story trails are often set up outdoors along existing paths and feature rotating selections of children’s picture books. Many story trails are set up and maintained by community groups, public libraries, or schools. Academic libraries can use story trails as opportunities to promote literacy, foster a sense of local community, support families, and encourage healthy habits. The authors of this article use City of Greenville (North Carolina) StoryWalks® created by staff at East Carolina University’s Joyner Library as an example story trail project. The project includes community partnerships, careful selection of titles and materials, and the facilitation of community events. The City of Greenville StoryWalks® project received overwhelmingly positive feedback from the community and serves as an example of how academic libraries can effectively serve the public with story trails.

Inflammation is critical in developing sarcopenia and sarcopenic obesity in older adults, yet evidence in younger populations remains scarce. This study examines associations of high-sensitivity C-reactive protein (hs-CRP) and systemic immune-inflammation index (SII) with sarcopenia and sarcopenic obesity among US adults. By using data from the 2015-2018 cycles of the National Health and Nutrition Examination Survey (NHANES), we conducted this cross-sectional analysis of adults aged ≥18 years. Overall, 4,870 participants were included, and both hs-CRP and SII values were divided into quartiles. Multivariable logistic regression was used to analyze the associations of hs-CRP and SII with both sarcopenia and sarcopenic obesity. Interaction tests were conducted to confirm model stability and identify individuals at high risk of developing sarcopenia. Multivariable logistic regression showed positive associations of SII and hs-CRP with sarcopenia and sarcopenic obesity. Compared to participants in the lowest SII quartile, those in the highest SII quartile had an increased odds of sarcopenic obesity (odds ratio [OR] 1.82, 95% confidence interval [CI] 1.24-2.67, p < 0.0022) and sarcopenia (OR 1.94, 95% CI 1.41-2.68, p < 0.0001). Participants in the highest hs-CRP quartile were also associated with significantly increased odds of sarcopenic obesity (OR 24.69, 95% CI 8.99-67.78, p < 0.0001) and sarcopenia (OR 6.09, 95% CI 3.89-9.53, p < 0.0001). Our findings extend the conclusions of previous studies conducted in older populations by demonstrating that systemic inflammation is also positively associated with the incidence of sarcopenia and sarcopenic obesity in younger adults. This finding suggests that individuals with an elevated inflammation level are more likely to develop these conditions. To our knowledge, this is the first study to report these associations in a younger adult population, offering reliable data and practical options for screening sarcopenia in high-risk community groups by using routine clinical tests. These findings support the potential of hs-CRP and SII as individual or combined screening tools to assess sarcopenia and sarcopenic obesity risk in community or large-population settings.

Childhood overweight and obesity represent major public health concerns globally, influenced by food and physical activity environments. In the absence of strong national or regional policies, there has been an increasing interest from local government jurisdictions to address obesity. This study aimed to apply three distinct participatory methods to engage different community groups in a medium size, socio-economically deprived municipality in Flanders (Belgium), to identify context-specific barriers and facilitators to healthy eating and physical activity from the perspective of these groups, and to propose locally relevant strategies. We used group model building with actors (local government officials, health representatives, school representatives and youth workers), Photovoice with children and interviews with parents and teachers. An inductive-deductive approach was used to analyse the different outputs and combine the barriers and facilitators across groups in different themes. In total, 15 actors participated in three group model building sessions, 66 children participated in five group Photovoice sessions, 14 children in one-on-one Photovoice sessions and 10 parents/teachers consented to an interview. Barriers and facilitators were identified across three themes: the obesogenic food environment (e.g. relative presence of healthy food outlets, supermarket proximity), the physical activity environment (e.g. an unsafe road environment discouraging active transportation, poorly designed play spaces) and the socio-economic environment (e.g. time and financial constraints for vulnerable groups, knowledge on poverty). By including the perspective of children and parents, actors could better understand the lived experience of their community and propose context-specific actions to tackle the identified barriers and facilitators. Proposed actions included offering healthy hot meals at school, attracting local markets to food deserts, designing car-free school streets, (re)designing playgrounds and increasing exchanges between community members and the local government. This study demonstrates a promising approach to meaningfully engage different community groups in identifying barriers and facilitators for healthy eating and physical activity at the local level. By addressing the barriers and facilitators across multiple settings, local governments can take concrete steps towards creating healthier and context-adapted environments for future generations.

Abstract Jember Regency, located in the southern part of Java Island, is adjacent to active offshore subduction zone, making it highly vulnerable to a potential megathrust tsunami. Six coastal districts within the regency are designated as tsunamis prone areas with critical dependence on coastal resilience. This study aims to formulate a comprehensive resilience strategy by identifying priority mitigation actions and mapping collaborative networks among key stakeholders in anticipation of a possible megathrust tsunami. The main contribution of this research lies in the integrated application of MICMAC and MACTOR methods, which is still rarely employed in the Indonesian context, to simultaneously analyze the relationships between mitigation variables and the power dynamics among stakeholders. Data collection was conducted through structured interviews and questionnaires involving 13 stakeholders, including government agencies, private sector/NGOs, academics, and community groups. The findings reveal that a resilience strategy for a megathrust tsunami in Jember’s coastal area involves seven key actions, with the Development of Disaster Risk Assessment Documents, Disaster Management Plans and Zoning Planning for Coastal Disaster Prone Areas identified as the most strategic variables (key drivers). The MACTOR analysis identifies the Regional Disaster Management Agency (BPBD) as the central actor, requiring strategic alliances with Public Housing, Settlement Areas and Human Settlements Office (DPRKPCK), Sub District Government, Academics, and Disaster Resilient Village as Community Groups. The study concludes that structural and non-structural approaches must be holistically integrated and supported by strong multi actor cooperation. Based on these results, this research serves as a foundational reference for technical implementation, recommending the establishment of a collaborative platform to facilitate sustained synergy among all stakeholders for enhanced tsunami resilience.

Public health emergencies disproportionately affect marginalized communities across the United States, challenging public health to address local-level factors contributing to persistent differences in community health outcomes. The Centers for Disease Control and Prevention (CDC) capability standards for public health preparedness recommend strengthening community partnerships to better understand and address these factors, including engagement of trusted community spokespersons. Even with growing governmental public health interest in community engagement, more examples are needed for deeper engagement across the public health emergency spectrum. Using 2 US-based case studies, we explore how to deeply engage communities throughout the preparedness-response-recovery continuum to help mitigate disproportionate outcomes of public health emergencies. Community-led groups in Detroit and Dearborn, Michigan and Helena, Arkansas identified priority public health challenges and advised on how to address them. In Detroit, Wayne State University's Hub for Evaluation and Learning set up a Community Steering Council that identified challenges in housing and mental health as key indicators of poor public health. In Helena, the Healthy Community Initiative, through its Community Action Board, identified and addressed a severe water crisis with input from community health workers. Both communities set up mechanisms for community members to share their concerns and help public health address these issues as part of their prevention strategies. Both communities reported improved capacity to identify and respond to public health crises through engagement with local leaders and creation of community-led groups for consistent involvement before, during, and after public health events. Local leadership groups are uniquely positioned to maintain relationships with communities at higher risk for negative public health outcomes. Such groups can draw upon community knowledge and assets to develop solutions tailored to area-specific assets and needs. Successful public health outcomes in disproportionately impacted communities are more likely when governmental public health considers community groups as integral to the public health infrastructure.

Trichinellosis knowledge and preventive practices in Mapuche communities of southern Chile: Evidence for targeted One Health implementation.

Older adults with (pre)frailty are vulnerable to deteriorations in physical functioning, mobility and independence. Evidence for frailty interventions utilizing existing services within primary healthcare structure is limited. The PromeTheus trial aimed to evaluate the effectiveness of a home-based, multifactorial, interdisciplinary intervention to prevent functional and mobility decline in (pre)frail older adults. In this multicentre, assessor-blinded, randomized controlled trial, 385 community-dwelling (pre)frail older adults (clinical frailty scale 4-6, ≥ 70 years) were randomly allocated (1:1) into the intervention group (IG: n = 196) or control group (CG: n = 189). The IG underwent the PromeTheus programme for 12 months, which included an obligatory unsupervised home-based physical exercise programme and facultative counselling services (person-environment fit, nutrition and coping with everyday life), implemented through existing healthcare services and referral to community group activities. The CG received usual care. The first primary outcome was the function component of the Late-Life Function and Disability Instrument (LLFDI-FC) after 12 months; Life-Space Assessment (LSA) served as the second primary outcome. Secondary outcomes included participation (short-form LLFDI disability component, LLFDI-DC), frailty status, physical capacity (Short Physical Performance Battery, SPPB) and fall rate. Data analyses followed the intention-to-treat principle. An exploratory stratified analysis according to baseline physical capacity (SPPB ≤ 6 points [n = 210] vs. SPPB > 6 points [n = 175]) was also conducted. Participants had a mean age of 81.2 ± 5.9 years, with 73.5% (n = 283) being female. At the 12-month follow-up, a significant between-group difference in favour of the IG was observed for the change in the LLFDI-FC (1.38 points, 95% confidence interval [CI] 0.08, 2.68) but not for the change in the LSA (0.49 points, 95% CI -3.65, 4.64). Change in frailty status (odds ratio for being in a 'better' change status 1.72, 95% CI 1.11, 2.64) and SPPB (0.58 points, 95% CI 0.10, 1.05) also showed significant between-group differences in favour of the IG. The intervention did not affect the short form LLFDI-DC or fall rate (p = 0.055-0.689). The stratified analysis showed significant improvements in the LLFDI-FC, short-form LLFDI-DC (limitation), frailty status and SPPB (p = 0.002-0.020) in the IG compared to the CG for participants with SPPB ≤ 6 points but not for those with SPPB > 6 points. There were no study-related serious adverse events. The PromeTheus programme had positive effects on physical functioning, frailty status and physical capacity but not on life-space mobility and fall rate in community-dwelling (pre)frail older adults. Participants with lower baseline physical capacity may benefit more from the programme.

This study examines the implications of the South China Sea maritime dispute on the security of coastal communities in the Philippines. Amidst the dominance of traditional security understandings oriented towards state sovereignty and military power competition, this study offers an alternative understanding that focuses on human security, particularly for community groups directly affected by the dynamics of this conflict. The escalation of the conflict triggers a security paradox, where state-centric security measures tend to neglect the protection of civilians in social, economic, and survival aspects. This study uses a Critical Security Studies framework with a descriptive qualitative method based on a case study of the Philippine territorial dispute in the South China Sea. The results show that the ongoing conflict not only impacts geopolitical stability but also significantly affects the lives of coastal communities.