Search Results (39)

This study investigates factors influencing migrants’ decisions to enter Europe via Bulgaria or Greece along the Balkan route, using logistic regression and machine learning models on data from the International Organization for Migration (IOM) Flow Monitoring Survey (August 2022–June 2025, $n=5536$). We examine demographic variables (age), push factors (economic reasons, war/conflict, personal violence, limited access to services, and avoiding military service), and governance clusters derived from the World Bank’s Worldwide Governance Indicators (WGIs). An adapted migration gravity model incorporates corruption control as a key push–pull factor. Key findings indicate that younger migrants are significantly more likely to choose Bulgaria ($\beta \approx -0.021$, $p<0.001$), and governance clusters show that migrants from high-corruption origins (e.g., Syria and Afghanistan) prefer Bulgaria, likely due to governance similarities and facilitation costs. The Cluster Model achieves a slight improvement in fit (McFadden’s $R^2=0.008$, AIC = 7367) compared to the Base (AIC = 7374) and Interaction (AIC = 7391) models. Machine learning extensions using LASSO and Random Forests on a subset of data ($n=4429$) yield similar moderate performance (AUC: LASSO = 0.524, RF = 0.515). These insights highlight corruption’s role in route selection, offering policy recommendations for origin, transit, and destination phases. Full article

This study explores economic and risk perceptions that spark off-shore irregular migration among West Africans through the Mediterranean Sea to countries of destination (CODs). This study is timely because deaths on the Mediterranean Sea, which are unprecedented in migration history, result in a need to create awareness and save lives. Grounded in the Theory of Reasoned Action and the Cultural Theory of Risk Perception, this study explores the economic and risk perceptions of off-shore irregular migration. This study comprised a literature review, otherwise known as a “meta study”. The study’s findings reveal that there is a nexus between a person’s attitude and behaviours in terms of human action. Human nurturing determines a person’s attitudes and behaviours. The human mind does what it wants when one is desperate for economic survival. This forces humankind to engage in dangerous activities to survive. Therefore, irregular migrants’ choice of unsafe routes through the Mediterranean Sea to CODs depends on their expected outcomes. Irregular migrants consider migration as an “insurance”, and flee from hardship towards opportunities. The perceptions that lead to this range from salary disparities to economic freedom. I argue that spiritual beliefs, peer pressure, media platforms, and personal factors influence irregular route choices. This study recommends collaboration among the ECOWAS, African nations’ governments, and the IOM to engage returning migrants to narrate their in-depth experiences about the routes’ dangers to create awareness. Returning migrants’ narratives should be disseminated in mass media and on social media platforms to target youth. This would discourage West African youth from choosing unsafe routes to CODs. Collaboration should be extended to youth training in entrepreneurship to equip youth as job creators rather than job seekers to curb unemployment, which usually sparks off-shore irregular migration. Full article

Proper hydration is essential for maintaining homeostasis and the effective functioning of physiological systems, including the nervous and circulatory systems. During adolescence, a period characterized by rapid somatic growth, hormonal maturation, and increased physical and mental activity, the demand for water increases significantly. Hydration affects not only the health of young people, but also their cognitive abilities, concentration, mood, and general well-being. Despite clear recommendations from institutions such as EFSA and IOM regarding daily fluid intake, numerous studies indicate that a significant proportion of young people do not achieve the recommended level of hydration. The school environment is particularly worrying, as young people spend a significant part of their day there, and the availability of water, health knowledge, and social conditions may contribute to dehydration or promote unhealthy choices (e.g., sweetened drinks). The aim of this article is to review the current state of knowledge on the importance of hydration in school-age adolescents. The physiological basis of hydration, the impact of insufficient fluid intake on the functioning of the young body, current guidelines, as well as the results of selected epidemiological studies and obstacles to ensuring optimal hydration in the school environment are discussed. Full article

Background: Maternal nutrition is one of the main determinants of healthy pregnancy outcomes. The aim of this study is to investigate maternal nutritional risks and their relationship with gestational weight gain (GWG) among Saudi women. Methods: This is a cross-sectional study conducted in the antenatal clinics of a university hospital. The FIGO Nutrition Checklist was used to investigate the nutritional habits of pregnant women attending their regular antenatal visits. The FIGO tool includes a brief food frequency questionnaire (FFQ) and total nutritional risk score (NRS). Data on other variables were collected, including participant demographics and obstetric history. Current weight and height were extracted from nursing notes of the current visit, and the pre-pregnancy weight was self-reported by participants. GWG was reported and participants were classified according to IOM Guidelines. All data were analyzed using SPSS (Version 30, release September 2024) and p < 0.05 was defined as statistically significant. Results: A total of 570 pregnant women participated in the study, of whom 96% had at least one nutritional risk. More than 90% of participants reported sufficient folic acid intake, normal hemoglobin level and adequate meat and poultry intake. Only 23.9% of participants had sufficient fish intake and 24.6% reported proper sun exposure. Additionally, 10% of participants scored poorly on the FFQ, while 30% were classified as high-risk based on NRS scale. Poor nutritional scores were not associated with any clinical or socioeconomical variables. According to IOM guidelines, 26.3% of the participants achieved adequate GWG, while 49.5% had inadequate GWG, and 24.2% exceeded recommended GWG. Inadequate GWG was most common among those with low pre-pregnancy BMI (60%), followed by overweight (43.2%) and obese (37%) women. Neither parity nor nutritional scores significantly influenced GWG. Conclusions: Although poor nutritional quality and high nutritional risk are relatively uncommon among Saudi women, the prevalence rates remain consistent across all sociodemographic groups. This suggests widespread, uniform patterns of suboptimal dietary habits within the community. While GWG was not affected by nutritional status or parity of the participants, nearly half of participants had inadequate GWG, particularly those with a low pre-pregnancy BMI. Full article

Background: Investigating fluid consumption among children and adolescents poses a challenge due to varying dietary behaviors and hydration needs. This systematic review aims to assess total water intake (TWI) and total fluid intake (TFI) in children and adolescents, focusing on gender differences and adherence to reference values proposed by the European Food Safety Authority (EFSA) and the Institute of Medicine (IOM). Methods: A systematic literature search of PubMed, Scopus, and Scholar was conducted to identify studies published between 2004 and 2024 reporting on TWI and TFI for children and adolescents. Studies were included if they reported fluid intake data in healthy populations, provided quantitative measures of TWI or TFI, and aligned with the EFSA or IOM reference values. From 8731 initial articles, 24 studies met the inclusion criteria. Data were synthesized narratively, and compliance with hydration guidelines was assessed. Results: The review included 24 studies, encompassing 16,254 children and 15,367 adolescents. The majority of participants failed to meet the recommended guidelines. Only one study reported compliance with the recommended TWI values, while four studies in children and four in adolescents showed adherence to the recommended TFI values. Conclusions: The results underscore a widespread inadequacy in achieving the hydration guidelines among children and adolescents, emphasizing the need for targeted interventions to improve fluid intake. Public health interventions are needed to promote adequate fluid intake, particularly in populations at risk of dehydration-related health outcomes. Future research should focus on identifying barriers to adequate hydration and developing targeted strategies to improve fluid intake behaviors. Full article

Background/Objectives: Screening for food insecurity, while common practice in pediatric populations, remains novel in pregnancy. Food insecurity during pregnancy is associated with medical comorbidities that in turn confer additional obstetric risks to the maternal–fetal dyad. Few studies have evaluated the impact of interventions for patients with food insecurity in the prenatal period. This study first demonstrates the ease of FI screening in pregnancy using the Hunger Vital Sign™ and next assesses if providing patients with a referral to a registered dietician decreases the incidence of inappropriate weight gain in pregnant patients with food insecurity. Methods: A retrospective chart review was conducted from November 2019 to March of 2021 at a United States Northeast inner-city hospital-based clinic to identify patients with food insecurity in the prenatal period. All pregnant patients who screened positive for food insecurity were given an educational pamphlet with resources and offered a referral to a registered dietician. We compared the incidence of appropriate weight gain among these patients depending on whether they attended an appointment with a registered dietician. We defined appropriate weight gain following the recommendations of the Institute of Medicine (IOM) based on pre-pregnancy body mass index. Inferential statistics were performed to compare differences using univariate statistics, and multivariate regression was conducted to control for confounders, with an alpha of 0.05. Results: In total, 139 patients screened positive for food insecurity (FI); 52 (37.4%) attended an appointment with a registered dietician. Overall, 88 (61.9%) patients had inappropriate weight gain during pregnancy. Fewer patients who attended a visit with a registered dietician had inappropriate weight gain than those who did not attend a visit (27 [30.7%] vs. 61 [69.3%], p = 0.031, respectively). Both study groups’ demographics, comorbidities, and postpartum outcomes were comparable. Conclusions: We found that for pregnant individuals with food insecurity, consultation with a registered dietician was associated with a decrease in the incidence of inappropriate weight gain during pregnancy. Full article

Controlling the Orobanche weed parasite is a major challenge for farmers, and the individual application of various management practices has not yet proven to be successful in addressing this issue. To develop an effective strategy for managing this parasitic weed, an Integrated Orobanche Management (IOM) approach has become a priority. Using a Discrete Choice Experiment (DCE) methodology, we analyze the trade-off in farmers’ preferences between different attributes of IOM scenarios and estimate their willingness to pay (WTP). A sample of 124 Tunisian faba bean farmers participated in the study. The findings indicate that Tunisian farmers are open to adopt an IOM that includes Orobanche-tolerant faba bean varieties, and that the cost of technical package does not seem to be an obstacle. Nevertheless, farmers feel to be rewarded for delaying the sowing date from November to December. Furthermore, the study highlights that farmers show no clear preferences for the use of herbicide, specifically glyphosate, as well as for the practice of intercropping with fenugreek. While increasing faba bean yields remains a priority, farmers are willing to pay more for IOM scenarios that reduce the Orobanche plant shoot count. In conclusion, there is significant heterogeneity in farmers’ preferences, their financial situation, and the severity of Orobanche infestation significantly influencing their decision. Policy recommendations are derived from our results. Full article

Background/Objectives: Vitamin D is essential for bone health, immune function, and overall well-being. Numerous ecological, observational, and prospective studies, including randomized controlled clinical trials (RCTs), report an inverse association between higher serum 25-hydroxyvitamin D [25(OH)D; calcifediol] levels in various conditions, including cardiovascular disease, metabolic disorders such as diabetes and obesity, susceptibility to infection-related complications, autoimmune diseases, and all-cause mortality. Results: Vitamin D operates through two distinct systems. The endocrine system comprises the renal tubular cell-derived circulatory calcitriol, which primarily regulates calcium homeostasis and muscular functions. In contrast, intracellularly generated calcitriol in peripheral target cells is responsible for intracrine/paracrine system signaling and calcitriol–vitamin D receptor-mediated genomic effects. Government-appointed committees and health organizations have developed various clinical practice guidelines for vitamin D supplementation and management. However, these guidelines heavily relied on the 2011 Institute of Medicine (IoM) report, which focused solely on the skeletal effects of vitamin D, ignoring other body systems. Thus, they do not represent maintaining good overall health and aspects of disease prevention. Additionally, the IoM report was intended as a public health recommendation for the government and is not a clinical guideline. Discussion: New country- and regional-specific guidelines must focus on healthy nations through disease prevention and reducing healthcare costs. They should not be restricted to bone effect and must encompass all extra-skeletal benefits. Nevertheless, due to misunderstandings, medical societies and other governments have used faulty IoM report as a foundation for creating vitamin D guidelines. Consequently, they placed disproportionate emphasis on bone health while largely overlooking its benefits for other bodily systems, making current guidelines, including 2024, the Endocrine Society less applicable to the public. As a result, the utility of published guidelines has been significantly reduced for clinical practice and RCTs that designed on bone-centric are generate misleading information and remain suboptimal for public health and disease prevention. Conclusions: This review and its recommendations address the gaps in current vitamin D clinical practice guidelines and propose a framework for developing more effective, country and region-specific recommendations that capture the extra-skeletal benefits of vitamin D to prevent multiple diseases and enhance public health. Full article

Objective: This study aims to evaluate the correlation of gestational weight gain (GWG) with pregnancy and perinatal outcomes in a cohort of obese women class I-III receiving standard care (SC) or lifestyle intervention (LI). Methods: This is a prospective cohort study including singleton obese women (body mass index, BMI ≥ 30) who delivered between 2016 and 2020. Women exposed to a LI were referred to an obesity weight management ad hoc clinic. Women followed by family centers or private settings represented the SC group. The LI started between the 9 and 12th week, consisting of a low-calorie diet and physical activity program. Pregnancy and perinatal outcomes were prospectively collected. Women included in the SC group were followed, simply checking their pregnancy and health status, providing general recommendations on a healthy lifestyle in pregnancy. GWG was categorized as insufficient, adequate, or excessive according to the Institute of Medicine (IOM). Results: A total of 1874 obese singleton women delivered in the study period. Among them, 565 (30.1%) were included in the LI while 1309 received SC. Women in SC showed a higher rate of GWG out of the IOM recommendations (excessive/insufficient), while women in the LI group showed higher adequate GWG. The small-for-gestational-age (SGA) rate resulted to be higher in the SC group. Once adjusting for age, BMI, country of origin, provider, and gestational hypertension, the risk for SGA was increased by insufficient GWG (OR = 1.25; 95%CI: 1.03–1.59), while it was reduced by LI (OR = 0.67, 95%CI: 0.42–0.98). Conclusions: In a cohort of obese women, the exposure to an LI was associated with more adequate GWG, reduced insufficient weight gain, and a decreased risk of SGA infants. Full article

A too-high gestational weight gain, in combination with steadily increasing obesity rates among women of reproductive age, represents an enormous obstetrical problem, as obesity and high gestational weight gain are associated with enhanced fetal growth, low vital parameters, and increased cesarean section rates. This medical record-based study investigates the association patterns between too-low as well as too-high gestational weight gain, according to the 2009 Institute of Medicine (IOM) guidelines, and fetal growth, as well as birth mode and pregnancy outcome. The data of 11,755 singleton births that had taken place between 2010 and 2020 at the Public Clinic Donaustadt in Vienna, Austria, were analyzed. Birth weight, birth length, head circumference, APGAR scores, and pH values of the arterial umbilical cord blood described fetal growth as well as the vital parameters after birth. Gestational weight gain was classified as too low, recommended, or too high according to the different weight status categories of the IOM guidelines. Birth weight, birth length, and head circumference of the newborn were significantly increased (p < 0.001) among underweight, normal-weight, and overweight women who gained more weight than recommended. Among obese women, only birthweight was significantly (p < 0.001) higher among women who gained more weight than recommended. Furthermore, a too-high gestational weight gain was significantly associated with an increased risk of macrosomia and emergency cesarean sections among underweight, normal-weight, and overweight women, but not among obese ones. Obese and morbidly obese women experiencing excessive gestational weight gain showed no significantly increased risk of macrosomia or emergency cesarean section. However, among obese mothers, a too-low gestational weight gain reduced the risk of emergency cesarean sections significantly (p = 0.010). Consequently, the IOM recommendations for gestational weight gain fit only partly for pregnant women in Austria. In the case of obese and morbidly obese women, new guidelines for optimal pregnancy weight gain should be considered. Full article

Maternal weight-status at various time-points may influence child obesity development, however the most critical time-point remains unidentified. We used data from the Healthy Growth Study, a cross-sectional study of 2666 Greek schoolchildren aged 9–13 years, exploring associations between childhood obesity and maternal weight-status at pre-pregnancy, during pregnancy/gestational weight gain, and at the child’s pre-adolescence. Logistic regression analyses examined associations between maternal weight-status being “below” or “above” the recommended cut-off points (WHO BMI thresholds or IOM cut-off points), at the three time-points, individually or combined into weight-status trajectory groups to determine the strongest associations with child obesity in pre-adolescence. Adjusted models found significant associations and the highest odds ratios [95% Confidence Intervals] for mothers affected by obesity before pregnancy (4.16 [2.47, 7.02]), those with excessive gestational weight gain during pregnancy (1.50 [1.08, 2.08]), and those affected by obesity at their child’s pre-adolescence (3.3 [2.29, 4.87]). When combining these weight-status groups, mothers who were above–above–below (3.24 [1.10, 9.55]), and above–above–above (3.07 [1.95, 4.85]) the healthy weight recommendation-based thresholds in each time-point, had a three-fold higher likelihood of child obesity, compared to the below–below–below trajectory group. Maternal obesity across all examined time-points was significantly associated with childhood obesity. Effective childhood obesity preventive initiatives should commence at pre-conception, targeting maternal weight throughout the life-course and childhood developmental stages. Full article

Total gestational weight gain (GWG) is identified as a strong and potentially controllable predictor of long-term health outcomes in women with gestational diabetes mellitus (GDM) and infants. When the total GWG of women with excess weight/obesity and GDM does not exceed the Institute of Medicine (IOM) suggested range, neonatal birthweight outcomes may be favorable, but the evidence is limited. Therefore, the objective of this study was to evaluate the dose-response relationship between increased total GWG and the risk of neonatal birthweight in Chinese women with excess weight/obesity and GDM. This study obtained electronic medical records (EMR) from the hospital information system (HIS) of the Chongqing Health Center for Women and Children between July 2017, and June 2020. A retrospective study analyzed the effect of the total GWG of women with excess weight/obesity and GDM on neonatal birthweight. The dose-response relationship between total GWG and neonatal birthweight was studied using a generalized linear model and embedded restricted cubic splines (RCS). The average age of all women with GDM was 31.99 ± 4.47 years, and 27.61% were advanced maternal age (≥35 years). The total GWG among women with excess weight and obesity and GDM greater than the IOM recommendations were found in 42.96% and 58.62% of cases, respectively. Total GWG in women with excess weight and excessing the IOM recommended range is a risk factor for large gestational age (LGA) [adjusted odds ratio (aOR) 0.1.47, 1.08–2.01] and macrosomia (aOR 1.55, 1.04–2.31). In the obesity above group, excessive weight gain increased the risk of LGA (aOR 2.92, 1.33–6.41) and macrosomia (aOR 2.83, 1.03–7.72). We used an RCS to examine pregnant women with excess weight and GDM and discovered a linear dose-response relationship between total GWG and LGA/macrosomia. In women with excess weight and obesity, increases in total GWG above the lowest end of the IOM recommendations range (7 kg and 5 kg) were associated with an increased risk of LGA and macrosomia. Therefore, research is urgently needed to support maternal and newborn health to provide recommendations for the ideal weight increase in women with excess weight/obesity and GDM. Full article

About 56% to 84% of pregnant adolescents have inappropriate (insufficient or excessive) gestational weight gain (GWG); however, the factors associated with GWG in this age group have not been systematically identified. This scoping review aimed to synthesize the available scientific evidence on the association of individual, family, and social factors with inappropriate gestational weight gain in pregnant adolescents. To carry out this review, the MEDLINE, Scopus, Web of Science, and Google Scholar databases were searched for articles from recent years. The evidence was organized according to individual, family, and social factors. The analyzed studies included 1571 adolescents from six retrospective cohorts, 568 from three prospective cohorts, 165 from a case–control study, 395 from a cross-sectional study, and 78,001 from two national representative samples in the USA. At the individual level, in approximately half of the studies, the pre-pregnancy body mass index (pBMI) was positively associated with the GWG recommended by the Institute of Medicine of the USA (IOM). The evidence was insufficient for the other factors (maternal age, number of deliveries, and family support) to determine an association. According to the review, we concluded that pBMI was positively associated with the GWG. More quality studies are needed to assess the association between GWG and individual, family, and social factors. Full article

Data on intraoperative neurophysiological monitoring (IOM) during spinal meningioma (SM) surgery are scarce. The aim of this study was to assess the role of IOM and its impact on post-operative functional outcome. Eighty-six consecutive surgically treated SM patients were included. We assessed pre and post-operative Modified McCormick Scale (mMCS), radiological and histopathological data and IOM findings. Degree of cord compression was associated with preoperative mMCS and existence of motor or sensory deficits (p < 0.001). IOM was used in 51 (59.3%) patients (IOM-group). Median pre and post-operative mMCS was II and I, respectively (p < 0.001). Fifty-seven (66.3%) patients showed an improvement of at least one grade in the mMCS one year after surgery. In the IOM group, only one patient had worsened neurological status, and this was correctly predicted by alterations in evoked potentials. Analysis of both groups found no significantly better neurological outcome in the IOM group, but IOM led to changes in surgical strategy in complex cases. Resection of SM is safe and leads to improved neurological outcome in most cases. Both complication and tumor recurrence rates were low. We recommend the use of IOM in surgically challenging cases, such as completely ossified or large ventrolateral SM. Full article

Background: Nutritional quality during pregnancy is crucial for mother and child health and their short/long-term outcomes. The aim of this study is to evaluate the adherence to nutritional recommendations in Italy during the three pregnancy trimesters in Normal Weight (NW) and Over Weight (OW) women. Methods: Data from a multicenter randomized controlled trial included 176 women (NW = 133; OW = 43) with healthy singleton pregnancies enrolled within 13 + 6 weeks of gestation. Dietary intake was assessed every trimester by a Food Frequency Questionnaire. Results: OW and NW had similar gestational weight gain. However, as Institute of Medicine (IOM) recommend lower gestational weight gain (GWG) for OW, they exceeded the suggested range. In both groups, caloric intake during the three trimesters never met recommendations. Protein intake in first and second trimester was higher than recommendations, as was sugars percentage. Dietary fiber intake was lower in OW. Polyunsaturated fatty acids, calcium, iron and folic acid requirements were never satisfied, while sodium intake exceeded recommendations. Conclusions: NW and OW women in Italy do not adhere to nutritional recommendations during pregnancy, with lower caloric intake, protein and sugars excess and inadequacies in micronutrients intake. Pregnant women in Italy should be provided with an adequate counseling and educational intervention as well as supplementation when indicated. Full article