Health Indicators Research Articles

Adapting the HSE-MS Indicator Tool for Academia: A Psychometric Evaluation of the Academic Teacher Stress Indicator Tool in Italian.

The assessment of work-related stress is mandatory in Italy, according to Legislative Decree 81/2008. The Academic Teacher Stress Indicator Tool (ATS-IT) was developed to address stress in academic teaching staff by adapting the Health and Safety Executive Management Standards Indicator Tool (HSE-MS IT). An online ATS-IT survey was administered to all teaching staff at the University of Trieste, yielding 334 valid responses. The survey also included a measure of psychosomatic complaints and demographic questions. Confirmatory factor analysis (CFA) was performed to test the six-factor structure, and reliability was assessed using Cronbach's alpha. CFA confirmed an excellent fit for the six-factor structure (CFI = .99; TLI = .99; RMSEA = .034). Reliability analysis mainly showed acceptable values (Cronbach's α ranging from .66 to .91). Significant gender differences were found in the Demands and Control scales, with additional differences based on age and academic role across multiple scales. The ATIS-IT scales were significantly intercorrelated and negatively correlated with psychosomatic complaints. The ATS-IT demonstrates good potential as a valid and reliable instrument for assessing work-related stress among Italian academic teaching staff. Its use can facilitate better stress management and intervention strategies in educational institutions.

Health benefits package selection in oncology: a clinical audit of palliative chemotherapy for breast cancer in an Indian health insurance scheme

BackgroundThe effective operation of health insurance requires functioning administrative processes, including appropriate filing for reimbursements. The unlisted palliative care package is one of the most utilized oncology packages within Indian state health insurance schemes. We conducted a clinical audit to evaluate the appropriateness of claims for this package for patients with breast cancer.MethodsWe obtained documentation submitted to support a random sample of insurance claims for the unlisted palliative care package for 50 patients (total) from one public and one private hospital, cataloged the available records, and assessed the appropriateness of package selection using clinical guidelines from India’s National Cancer Grid. Where sufficient documentation was available, we also assessed the clinical appropriateness of care. We also examined whether these patients received relevant care at other hospitals that participate in the scheme and, for five purposefully selected patients, whether additional documentation had been submitted alongside other claims.ResultsClaims for 45 of the 50 patients had sufficient documentation to assess whether the selected package was appropriate. Among these 45 claims only 33% were selected in accordance with guidelines; the public hospital had a relatively higher share of appropriate selections. In many cases (21 claims), the palliative care package was selected for adjuvant therapy and targeted therapy. While more than half of the sampled patients had multiple related encounters and sometimes received care from multiple hospitals, reviewing additional claims did not affect our conclusions.ConclusionClaims for the palliative chemotherapy unlisted package often had deficient documentation and were inappropriately selected.

Socio-economic, environmental and health impacts of dietary transformation in Bangladesh

Abstract The transition to healthier diets might be accompanied by trade-offs that occur in other parts of the food system. In this study the trade-offs between socio-economic, environmental, and health indicators were analyzed in different dietary scenarios for Bangladesh between 2022 and 2050. We used a global economic simulation model with updated national food consumption data, extended with a footprint module to track environmental impacts through the food value chain in Bangladesh and its trading partners. This study compares a business-as-usual (BAU) diet with the EAT-Lancet diet and the Bangladesh food-based dietary guidelines (FBDG). The BAU diet has a higher intake of animal products and sugar, and a lower intake of vegetables, fruits, legumes, and nuts than the EAT-Lancet and FBDG diets. We found that promoting a diet with more plant-based proteins has a strong positive impact on dietary health and an overall positive impact on the environment compared to the BAU scenario. This is due to the reduced impact of animal protein production on greenhouse gas emissions and the reduced impact of rice production on water use and nitrogen application. In addition, the transition to sustainable and healthy diets had minor impacts on the wages of low-skilled workers, Bangladesh’s self-sufficiency, and the affordability of food and cereals. In particular, the FDBG diet scenario scored best on diet and cereal affordability, as well as freshwater use compared to the other two scenarios. The decrease in the self-sufficiency ratio was comparable to the BAU diet scenario and smaller compared to the EAT-Lancet diet.

Reducing under-five mortality in Tanzania: insights from a 60-years data analysis on economic and health indicators

BackgroundUnder-five mortality in Tanzania remains a persistent issue, significantly affecting both the health and economic sectors. Despite various interventions, the under-five mortality rate (U5MR) remains high, impeding progress toward global health targets. This study investigates the factors influencing under-five mortality in Tanzania, focusing on the gross domestic product (GDP), malaria incidence, access to water, and access to sanitation.MethodsThe study employed data sets for Tanzania U5MR, GDP, access to water and sanitation, and malaria incidences from the World Bank for the years 1960–2020. Missing values are generated through the linear trend at point method. To analyses the data, correlation analysis and Bayesian linear regression are employed.ResultsThe analysis reveals significant relationships between the gross domestic product (GDP), malaria incidence, access to water, access to sanitation and under-five mortality. Furthermore, an increase in malaria incidences increase under-five mortality by 0.14 (14%), while access to water and sanitation exhibit an uncertain relationship. On the other hand, results show that an increase in the GDP lowers the likelihood of U5MR.ConclusionThese findings underscore the importance of economic development and public health interventions in reducing the child mortality rate. The study provides valuable insights for policymakers aiming to achieve Sustainable Development Goal (SDG) Target 3.2 by 2030, which aims for all countries to accomplish U5MR of 25 or less deaths per 1000 live births. By highlighting the relationships between these variables, the study contributes practical evidence to support efforts towards SDG 3.2, emphasizing the need for targeted interventions in both health and infrastructure sectors.

The importance of mental resilience in interpersonal communication and the unveiling of ressentiment – analysis of studies on young adults

Understanding certain mechanisms of mental resilience and the methods of communication in interpersonal relationships plays a crucial role in promoting healthy relationships and effective communication in the face of ressentiment. Research shows that despite improvements in some health indicators, mental health issues among young adults have intensified. The hypothesis proposed a connection between aspects of mental resilience that affect ressentiment and forms of interpersonal communication within this age group. The results confirmed this relationship, indicating a positive correlation between a proper attitude toward challenges and emotional well-being, and the recognition of others’ value. On the other hand, there was a negative correlation between emotional difficulties and the devaluation of others. These factors can evoke emotions such as envy, hatred, or reluctance, and negatively impact quality of life, increasing the risk of ressentiment. Shifting social structures and the visibility of competing groups deepen these emotional tensions as individuals attempt to reconcile their own success with societal values. The study included 142 young adults aged 18 – 35, with 54.2% being women and 45.8% men. Mental resilience was assessed using the Mental Resilience Scale by M. Ryś et al., while forms of communication were evaluated using a questionnaire based on Rosenberg’s concept, developed by M. Ryś and P. Kwas.

Enhancing CD4+/CD8+ T cell ratio and accelerating recovery in HNSCC patients through immunonutrition intervention

ObjectiveMalnutrition is a common issue in patients with head and neck squamous cell carcinoma (HNSCC), leading to compromised immune function and diminished treatment efficacy. This is particularly concerning for therapies targeting the PD-1 pathway, which are pivotal in cancer treatment. The aim of this retrospective study was to explore the potential benefits of immunonutrition in improving immune responses and clinical outcomes for these patients.MethodsIn the study, 49 individuals diagnosed with HNSCC were enrolled and divided into two groups: one group received specialized immunonutrition support designed to enhance immune function, while the other group received standard nutritional care. The researchers assessed immune function by evaluating CD4+ and CD8+ T cell counts, which are critical indicators of immune health. Additionally, clinical outcomes were monitored, focusing on infection rates and the duration of hospital stays.ResultsPatients who received immunonutrition showed a significant improvement in immune function, as indicated by higher levels of CD4+ and CD8+ T cells. Furthermore, these patients experienced shorter recovery times and lower infection rates compared to those receiving standard nutrition.ConclusionThese findings suggest that immunonutrition may play a vital role in enhancing the effectiveness of cancer therapies, including PD-1 inhibitors. By supporting immune health, immunonutrition could potentially improve patient outcomes and quality of life during and after treatment. This study underscores the importance of integrating nutritional support into cancer care, particularly for patients with HNSCC. As the field of oncology continues to evolve, incorporating strategies that address nutritional deficiencies could be key to optimizing treatment efficacy and improving overall survival rates.

Biodiversity and distribution of zoobenthos in the ecological water replenishment area of the Yellow River estuary coastal wetland revealed by eDNA metabarcoding.

The coastal wetland of the Yellow River Estuary, one of China's largest wetlands, is essential for biodiversity conservation and ecosystem services. Ecological water replenishment, a typical wetland restoration measure in the Yellow River Delta, has significantly impacted the habitat of zoobenthos, which are critical indicators of ecosystem health and water quality. However, the community characteristics of zoobenthos in this coastal wetland are poorly understood. This study utilized eDNA metabarcoding to assess the diversity and community structure of zoobenthos in the ecological water replenishment area of Yellow River Estuary Coastal Wetland. Zoobenthos from 174 families were identified, with 307 species recognized at the generic level, significantly more than those identified through traditional morpho-taxonomic approaches. Salinity emerged as a crucial factor in shaping these ecosystems. Contrary to expectations, in this study, brackish water exhibited the lowest species richness compared to freshwater and seawater, which may be attributed to local environmental stressors and fluctuating salinity conditions in the Yellow River Estuary. Environmental factors such as salinity, organic matter, and nutrient elements significantly influence the composition and distribution of zoobenthos. Specifically, cations, particularly Mg2⁺ and Ca2⁺, have a more substantial impact on zoobenthos than anions. Our results provide crucial information on zoobenthic biodiversity within ecological water replenishment areas, offering insights into the ecological dynamics and environmental factors shaping zoobenthos communities under ecological management.

Characterising the activity, lifestyle behaviours and health outcomes of UK university students: an observational cohort study with a focus on gender and ethnicity

BackgroundHealth-related outcomes and behaviours in university students are known to be poor relative to the general population. The substantial contextual shifts related to the COVID-19 pandemic, combined with increased numbers of students from minoritised ethnicity backgrounds and presenting as trans and gender diverse (TGD), means that up-to-date information is unavailable. The primary aim of this study was therefore to characterise the current movement, dietary and lifestyle behaviours, mental health, and Body Mass Index (BMI) of UK university students and assess differences between genders and ethnic groups.MethodsAn online, self-report survey was administered across three years (2021–2023). Three independent cohorts of university students’ (n = 6,327) completed the survey on four key topic areas. One-way ANOVAs were used to assess differences between genders (men, women, TGD), and independent samples t-tests were used to assess differences between ethnic groups (White, Minoritised Ethnicity).Results30% of students were not meeting physical activity guidelines, 54% were sedentary for ≥ 6 h·d− 1, 83% had poor diet quality, 51% were in high or increased risk groups for alcohol consumption, 18% experienced terrible or poor sleep quality, and 32% were overweight or obese. Gender differences were present for all variables other than walking physical activity (WPA) (P < 0.05), with men having better mental health and engaging in healthier movement and sleeping behaviours, whereas women had more healthful dietary and drinking behaviours, and TGD students had poorer outcomes compared to cis-gender students in most domains. Differences between White and minoritised ethnicity students were present for all variables other than sedentary behaviour, diet quality, WPA and BMI (P < 0.05); students of minoritised ethnicity engaged in better movement, drinking and sleep behaviours in addition to having more positive mental health than White students.ConclusionThe findings of the current study provide an update on the landscape of UK university students’ health and health-related behaviours. Overall, health-related outcomes and behaviours are poor in this population and these data suggest that gender and ethnicity play a role in determining students’ health and health-related behaviours. Therefore, these factors should be considered when developing strategies to promote healthy living in the context of higher education.

Investigating the causes of maternal mortality in Razavi Khorasan based on forensic medical records during the years 2015 to 2022

BackgroundMaternal mortality is among the main indicators of health in nations. Identifying the causes of maternal mortality is crucial in designing preventive interventions. Therefore, this study aimed to evaluate the causes of maternal mortality during 8 years.MethodsThis descriptive-analytical study was conducted on the archived cases of maternal mortality in the Forensic Medicine Department of the Khorasan Razavi Province between March 2013 and March 2022, but as no data was available for the first two years, maternal mortality data for 8 years was evaluated. Demographic characteristics, midwifery data, pregnancy care method, pregnancy care and delivery agent, insurance type, and confirmed cause of death were compared between the first and last five-year periods of the study.ResultsOverall, 250 cases of maternal mortality were identified in the study period. The prevalence of indirect and unrelated causes of maternal mortality was significantly higher in the last four-year period compared to the first four-year period (p < 0.001). The most common direct causes of maternal mortality in both periods were postpartum hemorrhage, eclampsia and gestational hypertension complications; and postpartum infection. Coronavirus disease 2019 (COVID-19) was the most common cause of maternal mortality in the last four-year period but the other common indirect causes of maternal mortality (cardiovascular disease and pulmonary embolism) were similar between the two periods. The most common unrelated cause of maternal mortality was accidents.ConclusionsPostpartum maternal mortality was higher than intrapartum period. Bleeding was still the main cause of maternal mortality. Despite the progress in prenatal care, it is necessary to improve intrapartum and postpartum quality of care.

Positive Impact of Prefabrication on the Mental Health of Construction Workers

Based on the literature-established benefits of prefabrication to promote better working conditions and its potential to enhance workers’ overall mental health, this study compares the state of mental health of traditional and prefabricated construction workers. In addition to the mostly adopted negative measures of mental health such as anxiety and depression, positive mental health indicators were also used to measure and compare overall mental health conditions of the two categories of construction workers. Data were collected with a questionnaire from 93 prefabricated factory-based and site-based construction workers in Australia. The survey contains eight items to measure poor mental health and seventeen variables of four sub-constructs of positive mental health (emotional, social, psychological, and cultural/religious well-beings). An independent samples t-test was employed to examine the significance of the differences between the means of traditional and prefabricated construction workers on the measured variables and their underlying constructs of mental health and well-being. The findings revealed significantly lower symptoms of burn-out (reduced task accomplishment), suicide ideation (feeling less interested in life), and depression among the workers in prefabricated projects. Similarly, prefabrication tends to provide a positive-mental-health-supportive environment, as the workers were found to be significantly healthier than traditional construction workers on the subjective measures of emotional, social, psychological, and cultural/religious well-beings. Assessing the predictive influence of prefabrication on the overall mental health of different groups of construction workers, especially with qualitative data from different samples in different times, is recommended for future studies.

Socio-economic inequalities in oral health among Portuguese older adults: a cross-sectional study

BackgroundAlthough the oral health status has improved in developed countries in recent years, oral diseases are still unequally distributed across socio-economic groups. Research on the impact of socio-economic factors on oral health care among older adults in Europe, including Portugal, remains limited. The main aim of this study was to investigate the association between socio-economic factors and oral health indicators in Portuguese older adults.MethodsThis retrospective cross-sectional study analyzed data from 915 participants (aged 65 years and older) from the third wave (2015–2016) of the Epidemiology of Chronic Diseases Cohort Study (EpiDoC), a population-based study. Socio-economic and demographic information, general health-related characteristics and oral health data (prosthetic need, oral hygiene frequency, and last dental procedure) were collected by questionnaire. Multivariate logistic and multinomial regression models analyzed the associations between socio-economic factors and oral health indicators.ResultsParticipants with lower education level, perceived lower income and a fewer number of private sector appointments were more likely to have poor oral health (need for prosthetic treatment, less frequent oral hygiene, and tooth extraction as last dental procedure). Other factors found to be associated with oral health were sex, age, geographical area, smoking habits, and body mass index.ConclusionsSocio-economic factors were associated with oral health in Portuguese older adults. These findings may contribute to future national public health strategies by expanding oral health services to ensure better access and coverage for at-risk groups.

Associations of Habitual Skeletal Loading with Bone Changes During the Menopausal Transition: A Follow-up Study.

While weight-bearing physical activity (PA) benefits bone health, it remains unclear whether PA can counteract hormone-driven menopausal bone deterioration. This secondary analysis of a population-based prospective follow-up study examined changes in bone health indicators around menopause and evaluated whether accelerometer-measured habitual skeletal loading is associated with these changes. A total of 189 initially perimenopausal women without estrogen therapy (mean age 52 [SD 2] years) were followed until they became postmenopausal (mean follow-up time 15 [9] months). Femoral neck bone mineral density (FN BMD) and bone mineral content (BMC) were measured with dual x-ray absorptiometry (DXA). Femoral and tibial shaft volumetric BMD (vBMD), cross-sectional geometry, and stress-strain index (SSI) were assessed using quantitative computed tomography (QCT) in a subset of 61 women. Habitual skeletal loads (mean daily osteogenic index [OI] and low, medium, and high-intensity impact counts) were evaluated with multiple-day free-living accelerometry records. Longitudinal associations of habitual skeletal loads and bone outcomes were analyzed with GEE models. Consistent decreases were observed in FN BMD and BMC, and femoral and tibial shaft vBMD and SSI (p < 0.001) over the follow-up. Slight decreases over the follow-up were also observed in OI and medium impacts in the full sample, and medium and high impact counts in the subsample (p < 0.05). Medium impacts were associated with tibial shaft vBMD and SSI (β = 0.204, 95% CI [0.018, 0.391] and β = 0.077 95% CI [0.000, 0.154], respectively). High impacts were associated with femoral shaft vBMD (β = 0.186 95% CI [0.006, 0.366]. However, no association was observed between habitual skeletal loads and changes in bone characteristics over the follow-up. We observed a rather uniform skeletal response to the menopausal transition at all measured bone sites. Positive associations were found between medium and high-intensity impacts and bone characteristics at the femoral and tibial shafts. However, habitual skeletal loading did not seem to counteract bone deterioration during the menopausal transition.

Exploring women’s sexual and reproductive health needs in Zabol’s suburbs, Iran: a qualitative study

BackgroundSuburban populations in developing countries are affected by poor environmental conditions affecting their ongoing health. Given the low reproductive health indicators of women residing in the suburbs of eastern Iran, planning to improve their health by assessing the needs of the target group through qualitative research is essential. The present study seeks to elucidate the views of women living in the suburbs of Zabol, Iran, regarding sexual and reproductive health needs.MethodsThis qualitative study was conducted in healthcare centers in the suburbs of Zabol in 2023. The sample comprised 22 women, including 16 women of reproductive age (age 15–49 years) living in the suburbs and six key informants (service providers and people who were in close contact with these women). The sample was selected purposively with maximum variation. Data were collected through semi-structured, in-depth, individual interviews, which continued until data saturation was reached. The data were then analyzed using conventional content analysis.ResultsThe data analysis yielded seven categories (gender-based violence, psychological problems, women’s lack of empowerment, barriers to equity in sexual and reproductive health, support seeking, sexual issues, and pregnancy, childbirth, and postpartum care needs) and 24 subcategories.The results revealed that suburban women did not have adequate information or knowledge about their sexual and reproductive health or the available services, and most of them suggested that they required training.ConclusionWomen living in the suburbs of Zabol were faced with challenges in their sexual and reproductive health and well-being. It is crucial to provide these women with sexual and reproductive health education and services that are accessible and suitable to their conditions by targeted interventions aiming to improve their health and well-being.The findings of the current study can serve as a basis for future health policymaking, planning, and research by providing evidence and strengthening the body of knowledge about this domain of health.

Being Cynical Is Bad for Your Wellbeing: A Structural Equation Model of the Relationship Between Cynicism and Mental Health in First Responders in South Africa

Cynicism has been associated with adverse mental and physical health outcomes. This study investigated the role of cynicism in relation to indices of mental health among South African first responders. Research has highlighted that first responders are at increased risk of adverse mental health outcomes owing to the nature of their work. The sample consisted of 429 participants who completed a brief demographic questionnaire and several research instruments: Turner Cynicism Scale, Chalder Fatigue Scale, Patient Health Questionnaire-9, and Generalized Anxiety Disorder Scale-7. Structural equation modeling was used to explore the relationship between cynicism and mental health indicators. It included a measurement model, which identified four latent variables—cynicism, fatigue, depression, and anxiety—and their respective indicators, and a structural model, which defined the relationships among these latent variables. Path analysis was used to explore the potential mediating role of fatigue in the relationship between cynicism and indices of mental health. The results demonstrated significant associations between cynicism and anxiety, depression, and fatigue. Fatigue also mediated the relationship between cynicism and indices of mental health. The results underscore the importance of recognizing and addressing cynicism as a critical factor in the mental health of individuals working in high-stress occupations.

Tropospheric and Stratospheric Ozone: Scientific History and Shifts in Early Perspectives Regarding the Impact on Human Health

This publication aimed at the revision of scientific publications on the discovery of ozone, tracing its scientific history and how the early perspectives of the beneficial ozone impact on respiratory diseases and how they shifted with advancements in scientific knowledge: once considered a health index, ozone is now recognized as an atmospheric pollutant with detrimental effects on human health. The global increase in tropospheric ozone exposure, along with the associated rise in morbidity and mortality, highlights the urgent need to reduce emissions of ozone precursors to protect public health. Given the large at-risk population, tropospheric ozone exposure poses a significant public health concern. To address this, it is crucial to implement strategies that mitigate the harmful effects of tropospheric ozone, especially for vulnerable individuals. If these measures are not effectively implemented, a worsening of health impacts can be expected. The October 2024 update on stratospheric ozone recovery reveals its fragility and erratic behaviour, underscoring the need for continued and stringent control measures to protect human health. To our knowledge, no prior publications have addressed such a comprehensive time frame as we have in this study.

Predicting the drift of small cetaceans stranded along the Atlantic coast of the Iberian Peninsula: Parametrization of the MOTHY drift model.

Marine mammal populations, particularly the common dolphin Delphinus delphis in the North-East Atlantic, play an essential role as indicators of ecosystem health. Effective monitoring of these populations is essential for assessing anthropogenic impacts, especially in the context of current threats such as fisheries bycatch. The MOTHY drift model, initially designed for oil spills and then adapted to carcass drift, is being used in part of the North East Atlantic (Bay of Biscay, English Chanel, and North Sea) to estimate the bycatch mortality of common dolphins. This study presents the parametrization of the drift model to estimate the bycatch mortality of common dolphins in the Iberian Peninsula waters. By comparing the actual stranding location of tagged dolphin carcasses off the Galician coast with their stranding location predicted by the drift model, we determined the best setting for the environmental input parameters. The results reveal that a 4 arc-minutes bathymetry resolution, coupled with consideration for currents, optimally predicts stranding locations in the Iberian Peninsula coast. The model's accuracy in predicting stranding locations is 18.25 ± 14.77 km. This adaptation not only contributes to the ongoing assessment of the impacts of bycatch on common dolphin populations in the Iberian Peninsula, but also provides a standardized methodology for estimating bycatch mortality at the population level. This work can also be used as a basis for further applications for other small cetacean species in wider distribution areas, supporting comprehensive population-level assessments and management strategies.

Soil Health and Ecosystem Services in Mangrove Forests: A Global Overview

This study analyzed the role of soil health (SH) and ecosystem services (ESs) in global mangrove research articles from 1958 to 2024. The SH approach is vital for evaluating mangroves’ ability to provide ES. However, most studies made no reference to these topics, an important gap that must be addressed. We performed a systematic literature review of the Scopus database using the following prompts: Level 1: “mangrove*” and “soil” or “sediment”; Level 2: “mangrove*” and “soil health” or “soil quality”; and Level 3: “mangrove*” and “soil health” or “soil quality” and “ecosystem service*” or “ecologic* service*”. A total of 8289 scientific articles were published that explored mangrove soils or sediments, of which 321 included a discussion of SH, and 39 discussed SH and ES. There is a historical preference for the term “sediment” in marine sciences. Carbon is the most studied topic. Six of the fifteen most productive countries are also among the fifteen with the largest mangrove areas. There is a scientific gap regarding studies that link mangrove soil studies with SH and ES. We recommend the development of a soil health index fully adapted to mangroves, considering their physical and geochemical dynamics, climate conditions, and anthropic relevance.

Adherence to Indian public health standards 2022 standards: a cross-sectional study on infrastructure of health and wellness centres in Amritsar district of Punjab

Background: After independence since 1952 basic healthcare services are primarily being delivered through primary health centres (PHCs). Recently, the government has expanded services with health and wellness centres (HWCs) to offer comprehensive primary care. Indian public health standards (IPHS) has formed the basis of their updation since 2007 with latest coming up in 2022. It is a general belief that infrastructure is lacking but no studies have been conducted to assess them in the border district of state of Punjab. Methods: An observational cross‑sectional study was conducted among 8 urban PHCs (UPHCs), 17 rural PHCs (R-PHC) and 28 sub health centres (SHCs) of district Amritsar UPHCs selected by Simple random sampling whereas RPHCs and SHCs selected by two stages stratified random sampling) where available infrastructure was assessed using a checklist developed on basis of IPHS 2022. Data was collected by observation and interview with medical officer and community health officer. Based on the checklist, overall scores were calculated where presence/absence of infrastructure were scored as 1/0. The PHCs were then classified into very good (&gt;80%), good (60-80%), average (40-60%), poor (&lt;40%). Results: Basic utilities like 24-hour electricity and water supply were available in 100% of R-PHCs, 89% of SHCs, and 100% of UPHCs. Fire safety measures were present in 50% of UPHCs, 35% of R-PHCs, and none of the SHCs. Residential facilities were available in 35% of R-PHCs, 4% of SHCs, and none of the UPHCs. Regarding clinical infrastructure, 70% of R-PHCs (24×7 and non 24×7) had inpatient wards, but none were equipped with minor OTs. In comparison, 62% of UPHCs (24×7 and non 24×7) had inpatient wards, and only 25% had minor OTs. Among SHCs, 89% had consultation. Overall, 83% of R-PHCs and 75% of UPHCs were graded very good or good, while 82% of SHCs were rated average or poor. Conclusions: While basic amenities were widely available, significant gaps in clinical and support infrastructure were identified, particularly in SHCs, which lack fire safety measures, functional residential quarters, and dedicated health and wellness areas. These deficiencies underscore the need for targeted investments to enhance infrastructure across all HWC levels.

An End-to-End Adaptive Method for Remaining Useful Life Prediction of Rolling Bearings Using Time–Frequency Image Features

The deep learning model has attracted widespread attention in the field of rolling bearing remaining useful life (RUL) prediction due to its advantages of less reliance on prior knowledge, high accuracy, and strong generalization. However, a large number of prediction models use very complicated artificial feature extraction and selection methods to build the original input features of the deep learning model and health indicator. These approaches do not fully exploit the capabilities of deep learning models as they continue to heavily rely on prior knowledge, The accuracy of their predictions largely hinges on the quality of the input features, and the generalization of manually crafted features remains uncertain. To address these challenges, in this paper, an end-to-end prediction model for the remaining useful life of rolling bearings is proposed, which is divided into three modules. First, a short-term Fourier transform module is incorporated into the model to automatically obtain the time–frequency information of the signal. Then, the convolutional next (ConvNext) module, which is a simple and efficient pure convolutional neural network, is utilized to extract features from the spectrogram. Finally, we capture the short-term dependence and long-term dependence by two parallel channels Transformer and self-attention convolutional long short-term memory (SA-ConvLSTM), and the self-attention mechanism is employed for the adaptive prediction of the bearing’s remaining useful life. Through integration with artificial intelligence, this method proposes a high-performance solution for predicting the remaining useful life of bearings. It has minimal reliance on manual labor, stronger fitting capabilities, and can be widely used for predicting the remaining useful life of bearings.

Normalized Difference Vegetation Index Prediction for Blueberry Plant Health from RGB Images: A Clustering and Deep Learning Approach

In precision agriculture (PA), monitoring individual plant health is crucial for optimizing yields and minimizing resources. The normalized difference vegetation index (NDVI), a widely used health indicator, typically relies on expensive multispectral cameras. This study introduces a method for predicting the NDVI of blueberry plants using RGB images and deep learning, offering a cost-effective alternative. To identify individual plant bushes, K-means and Gaussian Mixture Model (GMM) clustering were applied. RGB images were transformed into the HSL (hue, saturation, lightness) color space, and the hue channel was constrained using percentiles to exclude extreme values while preserving relevant plant hues. Further refinement was achieved through adaptive pixel-to-pixel distance filtering combined with the Davies–Bouldin Index (DBI) to eliminate pixels deviating from the compact cluster structure. This enhanced clustering accuracy and enabled precise NDVI calculations. A convolutional neural network (CNN) was trained and tested to predict NDVI-based health indices. The model achieved strong performance with mean squared losses of 0.0074, 0.0044, and 0.0021 for training, validation, and test datasets, respectively. The test dataset also yielded a mean absolute error of 0.0369 and a mean percentage error of 4.5851. These results demonstrate the NDVI prediction method’s potential for cost-effective, real-time plant health assessment, particularly in agrobotics.