ABSTRACT This phenomenological study explores the lived experiences of Indian women professionals engaged in workplace flexibility arrangements and examines how such arrangements influence career continuity. Despite the rapid adoption of hybrid and remote work models across India, limited qualitative evidence exists regarding their long-term impact on women’s professional growth. Using in-depth semi-structured interviews with 25 women professionals across IT, banking, education, and healthcare sectors, this study identifies five key themes: flexibility as empowerment, flexibility as hidden career penalty, managerial trust and support, intensified dual burden, and negotiated career aspirations. The findings reveal that flexibility enhances workforce participation and retention; however, structural biases, performance visibility norms, and socio-cultural expectations continue to shape advancement opportunities. The study contributes context-specific insights to gender and HRM literature in India and provides managerial recommendations for designing equitable and career-sustaining flexible work systems. Keywords: Workplace Flexibility, Women Professionals, Career Continuity, Phenomenology, Gendered Organizations, India.

North Korean defectors in South Korea offer a rare natural model to trace cancer risk evolution after rapid environmental transition, given shared genetics but markedly contrasting early life exposures with South Korean residents. Using the Korean National Health Insurance database, we constructed a nationwide matched cohort of 25,798 North Korean defectors and 1,276,601 South Korean residents (1:50 frequency matching by sex, age, and index year). We compared overall and site-specific cancer risks and examined time-varying hazard ratios (HRs) since resettlement. Overall cancer risk was higher among defectors (HR 1.13; 95% confidence interval, 1.07-1.18), particularly in men (HR 1.31). Liver (HR 2.53), uterine cervical (HR 2.10), and lung cancer (HR 1.69) were markedly elevated, reflecting infection- and deprivation-related legacies. In contrast, cancers more prevalent in developed countries, notably breast (HR 0.48) and colorectal (HR 0.71), were initially lower. However, HRs began to rise over time, especially for breast cancer, indicating a trend toward convergence with host-population patterns. The cancer profile of North Korean defectors demonstrates a dual burden: persistent risks from infection-related cancers rooted in pre-defection exposures and growing vulnerability to lifestyle-related cancers after resettlement. These findings highlight the importance of dual-track prevention strategies that address both legacy and emerging cancer risks in rapidly transitioning populations.

Malnutrition among school-going children in India has long been a public health concern, characterized by pronounced rural–urban disparities and a dual burden of undernutrition and overweight. This review provides a critical synthesis of evidence on the nutritional status of school-age children and examines the role of parental nutrition knowledge, attitudes, and feeding practices in shaping children’s dietary behaviors and nutritional outcomes. Structured searches of PubMed, Scopus, Web of Science, and Google Scholar, along with reports from national and international agencies, were conducted to identify peer-reviewed studies published between 2014 and 2024. The analysis indicates that rates of stunting and underweight remain higher among rural children, whereas urban children are increasingly exposed to poor-quality diets and overweight associated with nutritional transition. Parental nutrition education is positively associated with improved dietary diversity and modest improvements in selected anthropometric indicators across settings. The review recommends integrating systematic parental nutrition education into national programs such as PM-POSHAN and POSHAN Abhiyaan to strengthen family-based strategies, reduce rural– urban disparities, and enhance the overall effectiveness of child nutrition interventions.

Navigating Parenthood in the Shadow of Cancer: A Scoping Review of Healthy Parents' Experiences.

This qualitative study explores the induction experiences of Palestinian Arab novice teachers in Jewish-majority schools in Israel during a period of intense national tension (2023–2025). Amid ongoing teacher shortages in the Jewish sector and a surplus of qualified teachers in the Arab sector, Boundary-Crossing Teaching (BCT) has become a notable phenomenon. Using semi-structured interviews and reflective journals of 23 beginning teachers and eight mentors, the study investigates how minority educators navigate cultural and political divides in a conflict-affected society. The findings reveal that during periods of heightened tension, teachers’ professional identity is often overshadowed by ethnic suspicion, leading to a “dual burden” of professional and national representation. The data shows that teachers navigate national ceremonies through “strategic ambiguity”—performing outward compliance (e.g., standing for the siren) while maintaining internal identity boundaries. Furthermore, the study identifies a paradox in language dynamics: while Palestinian Arabic is often “securitized” and viewed with suspicion in staffrooms, teachers successfully leverage their linguistic background as “intercultural capital” to build empathy with students. The research finds that shared-identity mentors provide an essential “third space” for processing experiences of racism that are otherwise silenced within the school hierarchy. These empirical results demonstrate that teacher retention in conflict zones requires active institutional protection to prevent professional status from collapsing into national categorization.

Background & Aim: Musculoskeletal pain is a leading cause of long-term functional impairments globally, increasingly affecting younger populations due to sedentary lifestyles and academic stress. Despite growing international research, limited data exist on the interrelationship between musculoskeletal pain and stress among undergraduates in Sri Lanka. This study aims to determine the prevalence and distribution of musculoskeletal pain among final-year students at the University of Colombo and to assess its associations with stress level, body mass index (BMI), and musculoskeletal pain.Methods: A cross-sectional analytical study was conducted among 420 final-year undergraduates across five faculties of the University of Colombo. Musculoskeletal pain was assessed using the Standardized Nordic Musculoskeletal Questionnaire (SNMQ), while stress level was evaluated using a modified Student Life Stress Inventory (SLSI). BMI was calculated based on height(kg) and weight(m) (kg/m²). Data were analysed by descriptive statistics and inferential statistical tests including Pearson correlation test using SPSS version 26.Results: The 12-month and 7-day point prevalence of musculoskeletal pain were 82.1% and 64.5%, respectively. The lower back (48.8%), neck (46.7%), and upper back (42.4%) were the most affected regions, with 49.3% reporting interference with daily activities. Medical students showed the highest musculoskeletal pain prevalence (91.8%). A significant association was observed between stress level and musculoskeletal pain in the neck, shoulders, upper and lower back (p<0.05). BMI was significantly associated with lower back (p =0.018) and knee pain (p = 0.047). Females reported higher stress levels, especially in response to academic changes and pressures.Conclusions & Recommendations: Musculoskeletal pain is highly prevalent among final-year undergraduates at the University of Colombo, with stress emerging as a key contributor, particularly to axial pain. Context-specific interventions combining ergonomic and psychological strategies are essential to address this dual burden.

Background Recurrent pulmonary tuberculosis (PTB) after successful treatment is a significant challenge for current TB control efforts. This study investigated the epidemiological characteristics of recurrent PTB in western Zhejiang Province, aiming to identify risk factors for recurrence and predictors of retreatment outcomes, thereby providing a scientific basis for targeted prevention and management. Methods This retrospective cohort study utilized surveillance data from the Tuberculosis Information Management System in Quzhou, Zhejiang, from January 1, 2007, to December 31, 2024. Recurrence-free intervals were analyzed to identify temporal patterns, and multivariable Cox proportional hazards regression models were employed to determine independent risk factors for recurrence and adverse retreatment outcomes. Results Among 28,458 patients, 897 (3.15%) experienced recurrence. These cases were predominantly male (79.2%), older (mean age, 61.6 years), and farmers (80.3%). Recurrence-free intervals significantly shortened with subsequent episodes, dropping from a median of 804 days (95% CI, 740–900) for the first recurrence to 495 days (95% CI, 394–737) for the second ( p < 0.001). Nearly half (48.9%) of all recurrences occurred within the first 2 years after treatment. Independent predictors of recurrence included advanced age (Adjusted HR, 1.77 for ≥65 years [95% CI, 1.46–2.16]), male sex (AHR, 1.42 [95% CI, 1.21–1.67]), and farming occupation (AHR, 1.22 [95% CI, 1.02–1.46]). For retreatment outcomes, age ≥65 years was the independent risk factor for adverse events (AHR, 1.91 [95% CI, 1.07–3.40]). Conclusion Nearly half of the recurrences occurred within 2 years after treatment completion, and recurrence-free intervals progressively shortened with repeated episodes. The older population (≥65 years) faced a dual burden, identified as the primary risk group for both recurrence and adverse retreatment outcomes. For the risk factors of recurrence and the success of treatment, it is necessary to further refine and explore the influencing factors.

The phenomenon of the sandwich generation has become an increasingly visible social reality in the modern era, particularly as individuals face simultaneous responsibilities toward their aging parents and their dependent children. This dual burden places individuals in a unique socio-economic and emotional position where financial obligations, caregiving duties, and professional demands intersect. This study analyzes the multidimensional roles, challenges, and coping strategies experienced by the sandwich generation in navigating work, family, and mental well-being. The research highlights contributing factors such as rising living costs, increasing life expectancy, insufficient financial planning across generations, and strong cultural expectations of filial duty. Findings show that sandwich generation individuals often experience chronic stress, emotional fatigue, and role conflict due to overlapping responsibilities. However, effective time management, social support systems, self-care practices, and the utilization of digital tools can help mitigate the psychological strain. This study emphasizes the necessity of structural support both within families and through workplace policies to promote mental health and enhance resilience among the sandwich generation. Ultimately, strengthening awareness about intergenerational financial literacy, caregiving readiness, and mental-health preservation is crucial in reducing the long-term burden faced by this demographic group.

Integrating AI design tools into traditional design workflows: A study on collaborative tool usage willingness based on the Push-Pull-Mooring framework.

Background: Armed conflict creates a biological trap where acute malnutrition and chronic non-communicable diseases (NCDs) coexist and reinforce one another. Sixty-five percent of the world’s acutely food-insecure individuals live in conflict zones, facing dual burdens such as Gaza’s 150% surge in severe acute malnutrition (SAM) and Sudan’s 43% hypertension prevalence among displaced adults. This nexus is mediated through epigenetic reprogramming, microbiome collapse, and accelerated aging. The objective of this study was to evaluate how biologically, culturally, and life-stage-adapted precision nutrition strategies can address malnutrition and related infectious and NCD risks in conflict-affected populations. Methods: We synthesized literature on conflict-related malnutrition–NCD pathways and applied a precision nutrition framework to four case studies (Gaza, Sudan, Yemen, and Ukraine), emphasizing: • Biological tailoring (eg, micronutrient/gene screening); • Cultural adaptation (eg, moringa-based ready-to-use therapeutic foods [RUTF]); • Life-stage targeting (eg, prenatal epigenetic interventions). Results: Precision nutrition interventions demonstrated measurable benefits: • In Gaza, RUTF with water purification reduced diarrhea by 40% (95% confidence interval [CI]: 32%–48%), enhancing SAM recovery. • In Sudan, plant sterol-enriched rations lowered low-density lipoprotein [LDL] cholesterol by 12% (95% CI: 9%–15%) in famine survivors with cardiovascular risk. • In Yemen, FUT2-guided vitamin A supplementation reduced cholera incidence by 45% (95% CI: 37%–52%). • In Ukraine, a tele-nutrition and dietary approaches to stop hypertension [DASH]-diet voucher program reduced hypertension crises by 52% (95% CI: 45%–58%). Conclusion: Available evidence supports the potential role of precision nutrition in helping to alleviate the starvation–disease–trauma cycle in conflict-affected populations.

This study examined the structure of, relationship between, and changes in the burden of undernutrition (stunting) and overnutrition (overweight) among children under the age of 5 years living in the cities of Blantyre, Lilongwe, Mzuzu, and Zomba in Malawi. We analyzed the prevalence of undernutrition and overnutrition from the 2015/16 Malawi Demographic and Health Survey (MDHS), which we compared with anthropometric results of the 2024 MDHS that were published in the Key Indicators Report released in February 2025. We calculated the prevalence of moderate stunting and the contribution of severe stunting and moderate stunting to overall stunting in each city. Anthropometric results were available for a weighted sample of 256 children in 2015/16 and 351 children in 2024. Compared to 2015/16, prevalence of stunting and overweight increased in all cities, with Lilongwe, the capital, recording the largest increase in both stunting (86.7%) and overweight (118.6%). Except for Mzuzu city, which experienced a high prevalence of stunting (24.7%), the prevalence of stunting and overweight were very high (range 31.1%-41.5%) in the other three cities in 2024. Regarding overweight, prevalence ranged from medium (5 to < 10%) in Blantyre and Lilongwe to high (10 to < 15%) in Mzuzu and Zomba. The contribution of severe stunting to overall stunting more than quadrupled from 7% in 2015/16 to 30.6% in 2024 in Lilongwe. We conclude that children who live in Malawi's four cities have a dual burden of malnutrition, with very high prevalence of stunting and medium to high prevalence of overweight. Most of the children are moderately stunted. Nutrition policies and strategies for city dwellers should be formulated and implemented to improve nutrition. A larger study that aims to understand the structure and determinants of malnutrition in the cities is required.

Background/Objectives: This study aimed to evaluate the predictive value of the triglyceride-glucose index with body mass index (TyG-BMI) and the triglyceride-to-high-density lipoprotein-cholesterol (TG/HDL-C) ratio for predicting the occurrence of metabolic dysfunction-associated steatotic liver disease (MASLD) in obstructive sleep apnea (OSA). Methods: Data from patients diagnosed with OSA were analyzed in this retrospective cohort study. The participants were stratified into two groups: OSA alone and OSA with MASLD. The clinical characteristics and polysomnography data were collected. TyG-BMI and TG/HDL-C ratios were categorized into tertiles. Logistic regression and receiver operating characteristic (ROC) curve analyses were conducted to identify risk factors and assess their predictive performance for MASLD in OSA. Results: Among the 133 patients with OSA, 104 (78.2%) were diagnosed with MASLD. Multivariate analysis identified alanine aminotransferase (ALT), alkaline phosphatase, and TyG-BMI as independent risk factors for MASLD development in patients with OSA. Both TyG-BMI and TG/HDL-C ratio were significant predictors of MASLD in this patient population. The optimal cut-off values for TyG-BMI and TG/HDL-C ratio were 0.546 (sensitivity, 79.6%; specificity, 75.0%) and 0.539 (sensitivity, 93.2%; specificity, 60.7%), respectively. Combining TyG-BMI with ALT improved the predictive accuracy, yielding a cutoff of 0.696 (sensitivity, 76.7%; specificity, 92.9%). Similarly, the combination of TG/HDL-C ratio with ALT resulted in a cutoff value of 0.728 (sensitivity, 83.5%; specificity, 89.3%). Conclusions: TyG-BMI and the TG/HDL-C ratio are effective predictors of MASLD in patients with OSA. A combined model incorporating these indices with ALT levels demonstrated enhanced predictive accuracy for MASLD in this population. These indices are well-suited for risk stratification in resource-constrained settings facing a rising dual burden of OSA and MASLD.

Hypertension remains a dominant contributor to cardiovascular morbidity and premature mortality, with India experiencing a persistent dual burden of high prevalence and suboptimal diagnosis, treatment, and control. The North-Eastern Region (NER) of India is epidemiologically distinctive because of its heterogeneous ethnic composition, rugged geography, varied urbanization trajectories, and differential access to health services—features that can shape strong spatial patterning of cardiometabolic risk. The fifth round of the National Family Health Survey (NFHS-5, 2019–2021) enables an unprecedented district-level view of blood pressure indicators and related determinants, offering an opportunity to identify geographic inequities and intervention priorities. This review synthesizes peer-reviewed evidence relevant to hypertension in NER, with emphasis on geographic heterogeneity, measurement considerations, and gradients in screening and management. Thus, the paper discusses the methodological approaches for characterizing spatial distributions, interprets the likely drivers of spatial heterogeneity in the NER, such as the socioeconomic gradients, health-system reach, and behavioral risks, and outlines policy implications for targeting screening and treatment programs in hard-to-reach geographic settings. The review concludes by proposing a practical analytical framework for NER-focused impact of hypertension that balances interpretability, uncertainty communication, and program relevance.

Nutritional problems among primary school children remain a significant public health concern, particularly in the context of the dual burden of malnutrition. This study aimed to examine changes in students’ nutritional knowledge following a school-based healthy plate education intervention. A quasi-experimental pre–post design without a control group was implemented among 63 students from grades IV to VI. The intervention integrated visual media, interactive instruction, and practical demonstrations based on the “My Plate” concept. Knowledge levels were assessed using structured pre-test and post-test instruments and analyzed using the Wilcoxon Signed-Rank Test. The results showed a substantial shift in knowledge distribution, with the proportion of students in the “good” category increasing from 23.8% to 71.4%. Statistical analysis revealed a significant difference between pre-test and post-test scores (Z = -5.543, p &lt; 0.001), with a large effect size (r = 0.69). No participant experienced a decrease in score after the intervention. These findings indicate that school-based interactive nutrition education incorporating visual and experiential components can effectively enhance primary school students’ nutritional knowledge. Further longitudinal studies are recommended to assess the sustainability of behavioral changes.

Abstract Background: Treatment decision-making in metastatic breast cancer (MBC) is complex. In low-resource and conflict-affected settings, studies rarely address the psychological burden and personal preferences of patients that shape MBC treatment decisions. In Syria, women face unique barriers, including financial hardship, limited access to modern therapies, and psychosocial strain. No prior studies have examined how Syrian women with MBC make treatment cessation decisions amid conflict-related healthcare disruptions. We aimed to characterize patient perspectives on pausing vs. continuing therapy in MBC within a conflict-affected, low-resource setting. Methods: We conducted a cross-sectional mixed-methods survey between August 2025 and September 2025 on Syrian MBC patients. Quantitative measures assessed sociodemographic and clinical factors, as well as Likert scale ratings of attitudes and illness impact. Qualitative responses were thematically analyzed and quantified to identify dominant concerns and support needs. Results: This study included 60 Syrian women with a confirmed diagnosis of MBC. Participants had a mean age of 48.2 years, most were married (75%), and were from low-income households (68.3%). Over 70% had lived with breast cancer &amp;gt;5 years. Hormonal therapy was the most common treatment (38.3%), while chemotherapy (5.0%), radiotherapy (8.3%), and immunotherapy/targeted agents (8.3%) were less accessible. Illness burden was high (Mean daily life impact score 6.9/10). Systemic barriers were striking: 40% reported incurring transport costs and financial burdens, and 17% noted a deterioration in medical services. 66.7% feared their cancer would progress if treatment were paused, and 75% cited treatment toxicity or cost as reasons to consider a break. 70% expressed a need for better psychological support and communication from physicians. Conclusion: Syrian women with MBC navigate the dual burden of treatment toxicity and collapse of the healthcare system, compounded by overlooked psychosocial needs. Most patients were unwilling to discontinue therapy despite hardships, a decision that might be influenced by the perception that access to treatment in Syria is a luxury and a privilege. Addressing psychological support, patient preferences, and equitable treatment access is essential to optimizing care in conflict-affected settings Citation Format: A. Kouli, A. Al-Bitar, L. Mardini, O. s. Almansour, Johar, M. Saifo, F. Kalam, M. Hafez. Between Hope and Hardship: Patient Perspectives on Treatment Cessation in Metastatic Breast Cancer in Syria [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-12-14.

ABSTRACT Narratives create people and people create narratives as (re)shaped by lived religion. In Harare, poignant narratives unfold about the stories of “left-behind” youth who grapple with the dual burdens of precarity and longing as their parents and guardians seek better lives in diasporic enclaves. To crystallise the lived realities of these youth, the study engaged in qualitative research, employing in-depth interviews, field observations and reflective field notes. Thirty-three participants, aged 15–35, were drawn from community organisations, religious congregations and informal networks. Their narratives reveal a sense of liminality, where waiting transcends mere inaction, becoming a crucible for resilience and identity formation amid economic instability and emotional turmoil. Faith emerges as a fortifying force, providing solace and infusing their experiences with a shared belief in better days ahead, while vibrant youth cultures manifest as forms of resistance, asserting identities through various means.

Hemodialysis is a life-sustaining therapy for end-stage kidney disease, yet the devices enabling it paradoxically expose patients to chemical toxicants. Through long-term use, compounds such as di(2-ethylhexyl) phthalate, Bisphenol A (BPA) and its substitute Bisphenol S, N-methyl-2-pyrrolidone, and ethylene oxide leach from dialysis tubing, dialyzers, and other sterilized equipment. These substances, which have documented endocrine-disrupting, carcinogenic, and other toxic properties, pose significant health concerns. This comprehensive review synthesizes current evidence on hemodialysisspecific exposure levels, the toxicological profiles of these compounds, and their associated health impacts. These findings highlight the unique vulnerability of this population, who endure a dual burden of environmental and iatrogenic exposure. Consequently, the critical need for research into mitigation strategies, including alternative dialysis modalities and BPA-free membranes, and the development of safer materials that preserve functionality while minimizing patient risk is underscored. Cite this article as: Tarrass F, Benjelloun M. Toxicity assessment of long-term exposure to hemodialysis devices. Turk J Nephrol. Published online February 10, 2026. doi:10.5152/turkjnephrol.2026.251179.

Severe Obesity and Alpha-1 Antitrypsin Deficiency-Associated COPD: A Dual Burden on Health and Quality of Life.

Malaria and typhoid fever are major infectious diseases that pose significant public health challenges in many parts of the world, particularly in sub-Saharan Africa. This study develops a mathematical model to investigate the dynamics of malaria–typhoid co-infection, incorporating both vector and non-vector malaria transmission routes and environmental transmission for typhoid. Model parameters were drawn from the literature, and simulations were conducted in MATLAB. The results show that vector-borne transmission accounts for over 80% of malaria infections, while typhoid transmission sustains a persistent infection level. Co-infected individuals constitute approximately 25–35% of the total infected population at peak conditions, underscoring the substantial burden of simultaneous infection. Sensitivity analysis identifies malaria and typhoid transmission rates as key drivers of co-infection prevalence. A backward bifurcation in the malaria subsystem indicates that malaria may persist even when its reproduction number is below one, thereby continually seeding co-infection and indirectly maintaining typhoid transmission through co-infected individuals. These findings highlight the need for integrated and sustained control strategies, including vector control, typhoid vaccination, and improved sanitation, to effectively reduce the dual disease burden. Overall, the model provides a useful analytical framework to support public health planning and evidence-based resource allocation in regions where both infections remain endemic.

Despite high burdens of mental illness among people with type 1 diabetes (T1D), little is known about how affected individuals experience this dual disease burden. This qualitative study aimed to address this gap. Five online focus groups were conducted with 21 adults with T1D and a history of mental illness. We analysed data using a six-step descriptive phenomenological approach: (1) collecting data, (2) gaining an overall sense of participants' perspectives, (3) segmenting narratives into units of meaning, (4) synthesizing units into themes, (5) determining the structure of the phenomenon, and (6) integrating features into an essential description of living with T1D and mental illness. Two overarching themes were identified. The first, The Weight of Unseen Struggles, encompasses pervasive stressors, including the mental load of diabetes management, experiences of medical trauma, hypervigilance, burnout and the cyclical interplay between diabetes and mental health. These stressors manifest as a range of psychological and somatic symptoms, including depression, anxiety, obsessive thoughts and behaviours, sleep disturbances and trauma responses that affect daily functioning. The second, The Burden of Being 'Othered', highlights how interpersonal, institutional and societal factors contribute to experiences of judgement, stigma and ostracism. Adults with T1D endure a complex interplay of psychological, interpersonal and environmental stressors that exacerbate mental health symptoms and hinder treatment-seeking. Integrating tailored clinical psychological support within diabetes care settings and developing mental health intake policies for people with T1D may enhance access to mental health treatment and improve health outcomes.