Search Results (2,439)

Background/Objectives: Rising antimicrobial resistance threatens Helicobacter pylori eradication worldwide, yet real-world data on microbiologically confirmed treatment outcomes from the Middle East remain scarce. This study aimed to determine the confirmed eradication failure rate among treatment-naïve patients, identify independent predictors of failure, and characterize gaps in post-treatment testing practices. Methods: This retrospective cohort study included treatment-naïve adults diagnosed with H. pylori infection at King Abdulaziz Medical City in Riyadh between January 2015 and August 2023. The primary outcome was microbiologically confirmed eradication failure, defined exclusively as a positive post-treatment test of cure (urea breath test, stool antigen, or endoscopic biopsy). Exploratory logistic regression was used to identify factors associated with treatment failure. Results: Of 850 patients, 196 (23.1%) had a documented post-treatment eradication test. The confirmed failure rate was 33.7% (66/196). In multivariate analysis, atrophic gastritis (aOR 3.22, 95% CI: 1.29–8.02; p = 0.012) and pregnancy (aOR 12.76, 95% CI: 1.79–91.06; p = 0.011) were independently associated with failure. No treatment regimen was significantly associated with eradication outcome. Conclusions: One in three tested patients failed first-line eradication, and over three-quarters of treated patients never received a confirmatory test of cure. These findings support transitioning to bismuth-based quadruple therapy in line with current guidelines and local resistance data, mandating routine post-treatment eradication testing, and establishing antimicrobial susceptibility surveillance. Full article

Parental involvement is widely recognized as a key component of effective schooling, particularly in educational environments that emphasize community, developmental continuity, and holistic pedagogy. Alternative education models such as Waldorf schools have expanded internationally, yet empirical evidence on how parents perceive and structure their experiences within these institutions remains limited. This study investigates parental perceptions of Waldorf education in Hungary through a nationwide questionnaire survey of 585 parents whose children attend Waldorf schools. To explore the latent structure of parental evaluations, Exploratory Factor Analysis was conducted, followed by Confirmatory Factor Analysis to test the stability of the resulting model. The analyses identified four coherent dimensions of parental experience: Trust and Pedagogy, Community and Engagement, Perceived Long-Term Educational Prosperity, and Information and Transparency. Additional analyses examined how these dimensions vary according to institutional characteristics, parental participation in school community activities, and intentions regarding long-term enrollment. The results indicate that pedagogical trust constitutes a relatively stable evaluative dimension across institutions, while perceptions related to community engagement, long-term educational prospects, and transparency are more strongly associated with institutional maturity. Parents who intend to remain in Waldorf education until the completion of upper secondary schooling report consistently higher evaluations across all dimensions. By empirically identifying the structure of parental experiences in a European alternative education context, the study contributes to research on parental engagement, school choice, and the institutional cultures of alternative schooling. Full article

Objectives: We aimed to evaluate the reliability and validity of the Arabic version of the Chronic Heart Failure Health-Related Quality of Life Questionnaire (CHFQOLQ-20) among patients with heart failure in Jordan. Methods: A cross-sectional study was conducted among 399 adults with heart failure recruited from a tertiary hospital in Jordan (median age 68 years; 55.9% male). The CHFQOLQ-20 was translated using forward–backward procedures. Construct validity was examined using confirmatory factor analysis (CFA) and a multidimensional Partial Credit Model. Differential item functioning by sex and internal consistency were assessed. Results: CFA supported the original four-domain structure (physical, cognitive, mental, and general health), with all items showing significant factor loadings. Item-level analyses demonstrated acceptable model fit, ordered response thresholds, and minimal sex-related bias. Physical health scores were lower than other domains. Conclusions: The Arabic CHFQOLQ-20 is a valid, reliable, and multidimensional measure of HRQoL in patients with heart failure, supporting its use in clinical practice and research. Full article

Background/Objectives: To evaluate construct (convergent and divergent) validity and conduct confirmatory factor analysis (CFA) of the National Center on Health, Physical Activity and Disability (NCHPAD) Wellness Assessment (NWA) tool. Methods: A cross-sectional survey validation study utilizing secondary data. We assessed Spearman correlations between NWA and 36-Item Short Form Health Survey (SF-36), NWA and Godin Leisure-Time Exercise Questionnaire (GLTEQ) and NWA and Modified Fatigue Impact Scale (MFIS) scores to determine construct validity. A CFA was conducted to test the appropriateness of a three-factor model for NWA. Results: Data from 149 participants were used to assess construct validity and from 180 participants for CFA. Both correlations between NWA mental wellness domain and SF-36 mental component scores and between NWA emotional/spiritual wellness domain and SF-36 emotional well-being scores were 0.61 (p < 0.001 for both). The correlation between NWA physical wellness domain and SF-36 physical component score was −0.06 (p = 0.45). The correlations of NWA with GLTEQ overall and with health contribution scores were 0.26 and 0.30, respectively (p < 0.001 for both). The correlations of all NWA domain and MFIS subscale scores ranged between −0.42 and −0.25 (p < 0.05). The CFA model’s comparative fit index was 0.90. Conclusions: The NWA physical wellness domain did not demonstrate strong convergent validity, as mental and emotional/spiritual wellness domains did. All domains showed strong divergent validity, and CFA showed evidence supporting a three-factor model. Future efforts will emphasize refining and reevaluating the physical wellness domain until it achieves strong psychometric properties. Full article

Rework continues to be a critical issue in construction projects, contributing to cost escalation, schedule delays, and compromised quality. While earlier studies have identified isolated causes such as design deficiencies, communication failures, and inadequate workmanship, the structural relationships among these factors have not been sufficiently examined. This study investigates the interdependencies among major rework causation domains using Structural Equation Modelling (SEM) based on survey responses from 200 construction professionals. A total of 43 observed variables, identified through an extensive literature review, were grouped into four latent constructs: contractor-related, owner-related, design-related, and resource/workforce-related factors. Confirmatory Factor Analysis (CFA) was conducted to validate the measurement model, followed by structural path analysis to examine causal linkages. The findings reveal that design-related and owner-related factors exert the most significant direct and indirect influence on rework, followed by contractor- and workforce-related factors. The proposed model demonstrates satisfactory goodness-of-fit indices, confirming its reliability and applicability. Compared to conventional ranking and fuzzy-based approaches, SEM provides a more systematic and comprehensive understanding of rework dynamics. The findings provide practical guidance for project managers and decision-makers by identifying the most critical drivers of rework, enabling targeted mitigation strategies and improved resource allocation to enhance overall construction project performance. Full article

Background: Family caregivers remain closely involved in communication, care planning, and shared decision-making in long-term care (LTC) facilities. In this context, the quality of the relationship between family caregivers and professional staff may influence trust, collaboration, and satisfaction with care. However, few instruments have been specifically adapted to assess caregiver–staff relationship quality in Taiwanese LTC settings. Objectives: This study aimed to culturally adapt and preliminarily validate the Family Caregiver Relationship Quality (FCRQ) Scale for use in Taiwanese LTC facilities. Methods: A cross-sectional psychometric validation study was conducted with 205 primary family caregivers recruited from 20 LTC facilities in Taiwan. The original Relationship Quality Scale was adapted to the LTC context through contextual revision, expert review, bilingual verification, and pilot testing. Psychometric evaluation included confirmatory factor analysis, internal consistency assessment, convergent validity, and structural equation modelling with Bollen–Stine bootstrap correction to address potential non-normality. Results: The initial 16-item model required refinement, and three items with low standardized factor loadings were removed. The revised 13-item model met the prespecified fit criteria and showed acceptable internal consistency and convergent validity. The retained items reflected three conceptually related domains of relationship quality: trust, commitment, and satisfaction. Overall, the findings provided preliminary psychometric support for the adapted scale in Taiwanese LTC settings. Conclusions: The adapted FCRQ Scale may be a useful tool for assessing caregiver–staff relationship quality in Taiwanese long-term care facilities, particularly in the context of shared decision-making and family-centred care. Nevertheless, the findings should be interpreted as preliminary, and further validation in larger and more diverse samples is needed before broader clinical or research application. Full article

Entrepreneurship education has been promoted as a pathway for strengthening entrepreneurial orientation among university students; however, uncertainty remains regarding the mechanisms through which it influences entrepreneurial intention, particularly in emerging economies. This study examines whether entrepreneurship education influences the entrepreneurial intention of university students in Honduras indirectly through entrepreneurial self-efficacy and entrepreneurial motivation. A quantitative, cross-sectional, and explanatory study was conducted with a sample of 431 university students. Data were collected using a structured 56-item questionnaire with a seven-point Likert scale. The analysis was carried out through confirmatory factor analysis and structural equation modeling using the WLSMV estimator. The results show that entrepreneurship education positively influences all dimensions of entrepreneurial self-efficacy and entrepreneurial motivation included in the model. Personal attitude emerged as the strongest predictor of entrepreneurial intention, followed by subjective norms and specific dimensions of self-efficacy related to business planning and management and entrepreneurial leadership. In contrast, the innovation and problem-solving dimension did not show a significant direct effect on entrepreneurial intention, while perceived behavioral control showed a marginal effect. The parsimonious model explained 75.9% of the variance in entrepreneurial intention. Overall, the findings suggest that entrepreneurship education exerts its influence primarily through indirect pathways by strengthening capability beliefs and motivational appraisals that are proximal to action. Full article

This study develops and tests factor-based and holistic theoretical models to explain the relationships between Spatial Quality Satisfaction (SQS), Overall Dormitory Satisfaction (ODS), and Place Attachment (PA) in student dormitories. Data collected from 450 students residing in five state-run dormitories in Kırklareli, Turkey, via three 5-point Likert-type scales (validated by expert review and a pilot study), were analyzed using structural equation modeling, following exploratory factor analysis, confirmatory factor analysis, and Cronbach’s alpha validations. Findings from the factor-based Model 1 indicate that eight of the ten SQS factors do not significantly influence ODS and PA when considered individually, whereas “Emotional and Psychological Atmosphere” and “Flexibility of Use” emerge as key determinants. Additionally, this model reveals that ODS has a strong and positive effect on PA. Results from the holistic Model 2 demonstrate that SQS, when treated as an integrated construct, has a robust and significant effect on both ODS and PA, with ODS playing a significant mediating role in the relationship between SQS and PA. Overall, the findings suggest that students perceive spatial quality as a whole. Therefore, improving student dormitories through a holistic SQS approach is more effective in enhancing PA and ODS than interventions focused on individual spatial dimensions. Full article

Background/Objectives: Vaccine hesitancy remains a significant public health challenge worldwide, yet nationally representative data from Central Asia are scarce. Evidence on the multidimensional structure of vaccination attitudes and their social patterning in Kazakhstan is limited. The study aimed to assess the distribution of anti-vaccination attitudes among adults in Kazakhstan and to examine their associations with socio-demographic, behavioural, clinical, and territorial characteristics. Methods: We conducted a cross-sectional, nationally representative survey of adults aged 18–69 years across all 17 regions of Kazakhstan between May and October 2025 (n = 6712). A multistage, stratified cluster sampling design was applied, and analyses incorporated sampling weights and design-based corrections. Vaccination attitudes were measured using the 12-item Vaccination Attitudes Examination (VAX) scale, comprising four subscales: mistrust of vaccine benefit, worries about unforeseen future effects, concerns about commercial profiteering, and preference for natural immunity. Internal consistency and confirmatory factor analysis were performed. Design-adjusted linear regression models were used to identify factors independently associated with each subscale and the overall VAX score. Results: The weighted mean overall VAX score was 3.70 (95% CI 3.67–3.73) on a 1–6 scale. The highest scores were observed for worries about unforeseen future effects (4.12; 95% CI 4.10–4.14), followed by preference for natural immunity (3.93; 95% CI 3.87–3.98), concerns about commercial profiteering (3.49; 95% CI 3.45–3.52), and mistrust of vaccine benefit (3.27; 95% CI 3.23–3.31). Internal consistency was high for the overall scale (Cronbach’s α = 0.861), and the four-factor structure demonstrated acceptable fit (CFI = 0.965; TLI = 0.952; RMSEA = 0.071). In multivariable design-adjusted models, age showed a generally consistent gradient, with lower scores in younger groups and the clearest differences observed among the youngest respondents. Married/cohabiting respondents had lower adjusted scores than single respondents across all subscales and for the overall VAX score. Men had lower adjusted worries scores than women, but sex was not independently associated with the overall VAX score. Diabetes was associated with higher adjusted mistrust, concerns about commercial profiteering, and overall VAX score, but not with worries or preference for natural immunity. Territorial differences were domain-specific: urban residence was associated with lower mistrust and higher worries, while macro-region was significant at the factor level only for worries. Conclusions: Anti-vaccination attitudes in Kazakhstan exhibit a multidimensional structure and clear socio-demographic patterning. Concerns about long-term safety were the most prominent attitudinal domain, whereas mistrust of vaccine benefit was comparatively less pronounced. Territorial differences were domain-specific rather than uniform, supporting the need for targeted communication strategies tailored to specific attitudinal domains and population subgroups. Full article

This paper presents a holistic development model for South African schools that aims to ensure inclusive and equitable quality education and promote lifelong learning opportunities for all, as defined by the United Nation’s Sustainable Development Goal 4: Quality Education, by 2030. It addresses critical gaps in private secondary schools, including unclear performance objectives, inadequate monitoring, and limited data-driven decision-making. To meet these needs, the study proposes a new performance management model based on Kaplan and Norton’s balanced scorecard framework, combining four perspectives: Students, Academic excellence, Learning and growth, and Resources. Using a positivist approach, the model was validated by confirmatory factor analysis of 244 respondents across 12 private schools in Durban. The Comparative Fit Index, Normed Fit Index, and Tucker–Lewis Index confirmed its structural validity, while the Root Mean Square of Error Approximation indicated excellent absolute fit. Several intercorrelations emerged within the Learning and growth perspective, particularly regarding staff respect for students and their value to students. Implementation revealed an overall satisfactory performance rating of 3.85 on a 5-point scale. The Student perspective scored lowest (3.39), highlighting inadequate student preparation as a key issue, with learners’ pre-class reading of material scoring just 2.81. These findings underscore the model’s utility in identifying areas for improvement, particularly in student engagement, academic excellence, and organisational culture within the Learning and Growth dimension. Full article

Teacher well-being and performance represent critical challenges for educational systems worldwide. While organizational compassion has been identified as a protective resource, it remains unclear for whom compassion is most beneficial. Drawing on Job Demands–Resources (JD-R) theory and Conservation of Resources (COR) theory, we examined whether teachers’ self-efficacy moderates the relationship between workplace compassion and performance perceptions, testing differential patterns for individual versus organizational performance evaluations. Italian public-school teachers (N = 218; 82% female; M teaching experience = 11.6 years) completed an online survey measuring compassion at work, self-efficacy, and perceptions of individual and organizational performance. We employed a two-stage approach, first validating the measurement model through Confirmatory Factor Analysis (CFA), then testing moderation hypotheses using path analysis with mean-centered variables. Bootstrap confidence intervals (5000 iterations) verified the reliability of interaction effects. Self-efficacy significantly moderated the effect of compassion on individual performance perceptions (β = −0.006, p = 0.006; bootstrap 95% CI: [−0.010, −0.002]), revealing a compensatory pattern. Teachers with lower self-efficacy benefited substantially from workplace compassion (simple slope β = 0.31, p < 0.001), whereas teachers with high self-efficacy showed no significant benefit (β = 0.06, ns). The hypothesized synergistic effect on organizational performance perceptions was not supported (β = 0.006, p = 0.027; bootstrap CI included zero). Organizational compassion functions as a compensatory resource, most powerfully supporting teachers who lack personal resources. This challenges assumptions that organizational interventions uniformly benefit all employees and suggests that compassion-based interventions should be strategically targeted toward teachers experiencing lower self-efficacy. The study advances theoretical understanding of resource substitution mechanisms and provides actionable guidance for optimizing limited organizational resources in educational settings. Full article

The authors of this study aimed to develop and validate the College Students’ Coping with Public Health Crisis Scale (CSPHCS) among Chinese students, designed to assess coping strategies used during public health crises. This study had a rigorous, three-phase process comprising item development, scale development, and scale evaluation. Within these phases, a total of nine systematic steps were implemented. A total of 548 questionnaires were distributed, with 525 valid responses retained. A random subsample of 300 participants was used for exploratory factor analysis, and the remaining 225 were reserved for confirmatory factor analysis. The exploratory factor analysis revealed a three-factor structure after removing items with high cross-loadings. These factors were identified as (1) Information and Mental Health Support Coping, (2) Communication and Preventive Action Coping, and (3) Self-Regulatory and Expressive Coping, accounting for 50.14% of the total variance. The confirmatory factor analysis supported the three-factor model with acceptable fit indices (CFI = 0.887; TLI = 0.892; RMSEA = 0.077). The scale showed good reliability (α = 0.763, ω = 0.745). To sum up, the CSPHCS is shown to be a psychometrically sound instrument with implications for research and practice in understanding how college students cope with public health crises. Full article

This study modeled the factor structure of the Generalized Anxiety Disorder-7 (GAD-7), quantified its internal consistency, tested for longitudinal invariance, and estimated associations with measures of depression, parent stress, family functioning, and child psychopathology. Data were from 200 parents enrolled in an on-going study of children with chronic health conditions recruited from a pediatric hospital. Exploratory and confirmatory factor analysis (CFA) modeled the GAD-7 factor structure, and multiple-group CFA tested longitudinal invariance over 48 months. A one-factor model showed the best fit to the data, and the omega hierarchical was 0.89 and 0.88 at baseline and 48 months, respectively. The GAD-7 demonstrated longitudinal invariance. Internal consistency was good at both assessments (α > 0.75). Correlations with other measures were significant and at least small in magnitude. Known-group validity (parents with vs. without depression) showed very large effects (d > 2.0). The GAD-7 is psychometrically robust in parents of children with chronic health conditions. Full article

Background/Objective: Athletes’ dietary needs are influenced by the physiological demands of their sport, so the impacts of disrupted food access may vary from those experienced by the general population. This study aimed to develop and validate the Athlete Food Insecurity Scale (AFIS), a sport-specific tool designed to measure food insecurity in athletes. Materials and Methods: The study included 500 young adult athletes from 18 different sports disciplines. The sample was divided for exploratory factor analysis (n = 300) and confirmatory factor analysis (n = 200). Standard procedures for scale development were followed, including content validity assessment, construct validity testing, convergent validity analysis, and reliability evaluation. Results: The final 23-item scale demonstrated a four-factor structure including performance changes, coping strategies, basic nutritional needs, and physical access restraints. Factor loadings ranged from 0.344 to 0.956, item–total correlations from 0.513 to 0.781, and Cronbach’s alpha coefficients from 0.827 to 0.937. Confirmatory factor analysis supported the modified model with acceptable fit indices (χ²/df = 2.41, RMSEA = 0.080, TLI = 0.900, CFI = 0.910), and standardized factor loadings ranged from 0.53 to 0.89 (p < 0.05). Subscale scores differed significantly across Household Food Security Survey Module food security categories, supporting convergent validity. Conclusions: The AFIS demonstrates strong psychometric properties and may provide a sensitive tool for identifying and monitoring sport-specific food insecurity among athletes. Full article

Background/Objectives: Grounded in Self-Determination Theory, this study aimed to translate and validate the Basic Psychological Need Satisfaction and Frustration Scale (BPNSFS), including the Novelty dimension, within the Portuguese exercise context. Given the emerging evidence of novelty as a potential candidate for a basic psychological need, this research examined the psychometric properties and temporal stability. Furthermore, this study explored the nomological validity of these constructs regarding exercise enjoyment and satisfaction with life. Methods: The sample comprised 500 gym-goers (263 females; 237 males), aged between 18 and 65 years (M = 33.76; SD = 12.94). Confirmatory Factor Analysis and Exploratory Structural Equation Modeling were employed to compare the factor structure. Temporal stability was assessed through a test–retest procedure with a four-week interval (n = 50). Results: Exploratory Structural Equation Modeling provided a superior fit to the data (CFI = 0.98; TLI = 0.97; RMSEA = 0.04) compared to Confirmatory factor Analysis, supporting the distinctiveness of the eight dimensions. The instrument demonstrated strong internal consistency (composite reliability ranging from 0.78 to 0.90) and adequate discriminant validity. Path analysis revealed that novelty satisfaction was significantly associated with enjoyment and satisfaction with life. In reverse, novelty frustration was negatively associated with these well-being indicators. Intraclass correlation coefficients (0.75 to 0.83) confirmed robust temporal stability. Conclusions: These findings provide evidence that the Portuguese version of the BPNSFS, including the novelty dimension, is a psychometrically comprehensive instrument for the exercise context. The results support the inclusion of novelty as a relevant psychological need within Self-Determination Theory. Full article