Search Results (45,290)

Background: Maternal healthcare access is a critical determinant of women’s and neonatal health, especially in rural areas of low- and middle-income countries. Despite high reported utilization in South Africa, rural communities continue to experience adverse childbirth outcomes. Objective: To evaluate the association between maternal healthcare access and childbirth outcomes in Ingquza Hill Local Municipality, Eastern Cape Province of South Africa. Methods: A cross-sectional study was conducted among 213 pregnant and postpartum women receiving maternal healthcare services at St Elizabeth Hospital, a regional referral hospital serving multiple primary healthcare clinics across the municipality. Data were collected using structured questionnaires and maternity access indicators (including ANC attendance, timing of first ANC visit, number of visits, physical accessibility, and place of delivery), and childbirth outcomes. Logic regression analyses were performed to identify associations between access indicators and unfavorable childbirth outcomes. Results: Utilization of maternal healthcare services was high, with 96% of participants reporting ANC attendance, 92% receiving skilled care during pregnancy, and 91% delivering in a health facility. Unfavorable childbirth outcomes were observed in 12% of participants. Conventional indicators of maternal healthcare access, including ANC attendance, number of visits, physical accessibility, and place of delivery, were not statistically associated with childbirth outcomes in regression analyses. However, initiation of antenatal care was notably delayed, with a mean gestational age at first ANC visit of 21.7 weeks. The limited number of adverse outcomes constrained statistical power to detect modest associations. Conclusions: High maternal healthcare utilization alone did not ensure improved childbirth outcomes in this rural setting. Delayed initiation of antenatal care emerged as a critical gap that may limit the effectiveness of subsequent care, highlighting the limitations of coverage-based access indicators. Strategies to improve maternal and neonatal outcomes should prioritize early antenatal engagement, quality and continuity of care, and move beyond utilization metrics toward measures of effective coverage in rural and resource-limited contexts. Full article

Background/Objectives: Topical corticosteroids (TCS) are a cornerstone of dermatological treatment for inflammatory skin conditions; however, irrational fear of their use known as corticophobia undermines adherence and worsens clinical outcomes. This study investigated the prevalence of TCS-related concern and phobic behaviors among the general population in Saudi Arabia and identified factors associated with TCS-related concern and phobic attitudes. Methods: A cross-sectional study was conducted between October and December 2025 using an online self-administered questionnaire distributed via social media platforms among a non-probability convenience sample across multiple geographic zones of Saudi Arabia. A total of 481 participants were enrolled. Descriptive statistics summarized demographic and clinical characteristics. Chi-square and Fisher’s exact tests were used to examine differences in proportions between categorical variables and TCS concern, while independent-samples t-tests and one-way ANOVA compared mean phobia scores across subgroups. Results: Of 481 participants, 254 (52.8%, 95% CI 48.3–57.2) expressed concern about TCS use. The predominant reason for refusing prescribed TCS was fear of side effects (93.5%). Phobic behaviors included fear of long-term use (54.2%) and fear of application to sensitive skin areas (63.0%). On the Likert phobia-scale item, 237 (49.8%) totally agreed they would use TCS if prescribed; a separate dichotomous behavioral-intention item, administered only to non-current users (n = 308), showed that 201 (65.3%) would accept TCS if prescribed and 107 (34.7%) would refuse. Concern was significantly more prevalent among females (58.1%, BH-adj p = 0.005), married participants (61.7%, BH-adj p = 0.010), and those refusing prescribed TCS (77.6%, BH-adj p < 0.001). Mean phobia scores (theoretical range 7–28) were significantly higher among females (20.43 ± 4.06 vs. males 18.84 ± 4.68, p < 0.001), participants with Diploma-level education (21.64 ± 3.12, p < 0.001 across education strata), widowed/divorced individuals (21.82 ± 3.57, p = 0.008), and residents of the Southern (20.47 ± 3.99) and Northern (21.40 ± 3.34) regions (p = 0.002 across regions). Conclusions: TCS-related concern was expressed by over half the participants in this social media-recruited sample, posing a substantial barrier to effective dermatological care. Side-effect concern was the most frequently reported reason for refusing prescribed TCS. In adjusted analyses, female sex was the most consistent independent correlate of TCS-related concern and higher phobia score; married status was independently associated with greater concern. These associations should be replicated in probability-based samples before subgroup-targeted interventions are designed. Conclusions: TCS-related concern was prevalent (52.8%) among adults in Saudi Arabia and represented a substantial barrier to dermatological care. Female sex and married status were independently associated with greater concern. Clinicians should proactively address TCS misconceptions during dermatological consultations to improve treatment adherence. Full article

Mental well-being has been considered a fundamental contributor to overall academic success and psychological stability. Based on the Transactional Theory of Stress and Coping, this study examined the mediating role of academic resilience in the relationship between perceived academic support and mental well-being of Kenyan TVET trainees. A quantitative cross-sectional design was employed, with a sample of 1933 trainees (M_age = 22.87 years; 57.7% male) from 239 public TVET institutions in Kenya. The following measures were administered: Perceived Academic Support Questionnaire, Academic Resilience Scale, and the Short Warwick–Edinburgh Mental Well-Being Scale. Correlation analysis demonstrated that perceived academic support showed a strong positive association with mental well-being, whereas academic resilience indicated a moderate association. Consistent with the hypothesized model, parallel mediation analysis indicated that academic resilience partially mediated the relationship between academic support and mental well-being. The indirect effects observed across resilience dimensions indicated that emotional response was the dominant mediating pathway, while perseverance showed a small positive indirect effect, and adaptive help-seeking demonstrated a small but significant negative indirect effect. These findings contribute to the growing but limited literature on well-being in vocational training and suggest that while academic resilience serves as a key mediating mechanism, perceived academic support may also function as a direct protective factor, underscoring the importance of embedding structured emotional coping support within TVET academic environments. Full article

Parental divorce, as an adverse childhood experience, may disrupt family systems and exert enduring effects on psychological development, with impacts becoming particularly salient during emerging adulthood, a stage characterized by identity exploration and increasing autonomy. Within the Thai cultural context, inner strengths grounded in Buddhist values may serve as important resources for resilience. This study examined associations between inner strength dimensions derived from the Ten Perfections (Pāramīs) and resilience among emerging adults who experienced parental divorce in childhood. A cross-sectional design was employed with 160 Thai participants aged 20 to 29 years, who completed the Inner Strength-Based Inventory (I-SBI) and the Resilience Inventory (RI-9). Correlation analysis indicated that equanimity, determination, perseverance, wisdom, meditation, and loving-kindness were positively correlated with resilience. Multiple regression analysis showed that equanimity (β = 0.312, p < 0.001), determination (β = 0.227, p < 0.01) and loving-kindness (β = 0.213, p < 0.01) were significantly associated with resilience. These findings suggest that culturally embedded inner strengths are associated with resilience in a non-Western context. More specifically, among the ten dimensions examined, equanimity, determination, and loving-kindness emerged as being significantly associated with resilience in Thai emerging adults with childhood parental divorce experiences. Full article

Aiming at the challenging issue of nonlinear coupling control between cooling intensity and solidification rate in the secondary cooling zone of round billet continuous casting, this study proposes an efficient 3D temperature field modeling method that integrates hybrid coordinate systems with equal-area meshing. The model is applicable to the temperature range of 800–1520 °C during the continuous casting process. With the modeling strategies of constructing an r-θ-z hybrid coordinate system and designing a dynamic equal-area meshing method, and combined with a topological structure optimization algorithm, the geometric adaptability and numerical stability of the model are significantly improved. Based on this, an explicit-semi-implicit dual-mode finite difference solution model is developed, where the explicit scheme meets real-time online calculation requirements, and the semi-implicit scheme combined with preconditioned Gauss–Seidel iteration enables high-precision offline simulation. Furthermore, a boundary condition model incorporating adaptive mold heat flux correction and multi-mechanism heat transfer in the secondary cooling zone is established. Based on Microsoft Visual Studio 2019 (Version 16.11) C++ development, SIMD vectorization and temperature gradient threshold optimization technologies are employed, resulting in a 35% improvement in computational efficiency. Industrial validation results show that, taking 42CrMo steel with a casting speed of 0.24 m/min and a cross-section of φ600 mm as an example, the deviation between the calculated surface temperature (887 °C) and the measured value (876 °C) of the round billet in the straightening zone is only 11 °C, and the calculation error of the cold billet diameter is only 0.325% (with a calculated value of 597.548 mm and a measured average value of 599.5 mm), both meeting the accuracy requirements for engineering applications. The model breaks through the limitations of traditional empirical formulas and provides theoretical support for digital control of continuous casting processes and quality optimization of high-alloy steels. Full article

Firearm homicide is a leading cause of death among children and young men in the U.S. (ages 1–19), with young Black males in urban environments facing rates 18-to-24-fold higher than their non-Hispanic White peers in 2023. A key precursor to firearm violence victimization is weapon-carrying behavior (WCB), defined as carrying, concealing, or displaying firearms or other weapons in community or social contexts that elevate risk for injury, interpersonal threats, or law enforcement contact. Several structural, behavioral, and trauma-based risk factors fuel weapon-carrying. Yet these WCBs are rarely studied in tandem, leaving a critical gap in our understanding of these high-risk behaviors for youth. This cross-sectional study leveraged baseline data from a convenience sample of 226 violence-exposed urban young Black males, ages 15–24 (M_age = 18.3 years; SD = 3.1) enrolled in a trauma-informed digital firearm violence prevention pilot study. Eligibility required prior personal or witnessed experience of youth violence; reported prevalence therefore characterizes a high-risk subgroup rather than urban young Black males as a whole. Past-30-day weapon-carrying frequency was measured across five YRBS-aligned categories (0, 1, 2 to 3, 4 to 5, and 6+ days) and modeled as a categorical index under negative binomial regression. Associations with peer and community violence exposure, substance use, sociodemographic, and socioeconomic factors were estimated as incidence rate ratios (IRRs) with 95% CI. Past-30-day weapon carrying was reported by 42.5% of participants, with carrying frequency ranging from 1 day to 6 or more days. Participants reported high levels of direct victimization (64.8%), witnessing community violence (76.4%), and use of nonprescribed medications, including in instances preceding violence. In the fully adjusted model, indicators of violence exposure were the most consistent correlates of carrying. Direct victimization (IRR = 1.15, p < 0.05), general exposure to violence or aggression (IRR = 7.82, p < 0.01), and physical fighting (IRR = 1.11, p < 0.05) remained independently significant. Conversely, associations with substance use, dating aggression, and employment were attenuated, suggesting shared ecological vulnerability rather than independent causal pathways. Findings underscore the central role of chronic violence exposure and support the need for trauma-informed, multilevel prevention strategies in clinical and community settings. Full article

Despite extensive research on corporate governance compliance and firm-level outcomes, limited attention has been paid to how internal organizational structures, particularly business complexity and decentralization, shape governance effectiveness across institutionally differentiated emerging markets. This study examines these relationships within the Palestinian and Jordanian capital markets, which provide a relevant comparative setting due to differences in governance enforcement, institutional maturity, and sustainable governance adaptation. Grounded in agency theory, transaction cost theory, and contingency theory, the study adopts a comparative cross-sectional design using documentary data from non-financial firms listed on the Palestine Exchange (PEX) and the Amman Stock Exchange (ASE) for the 2023 fiscal year. Composite indices for governance effectiveness, decentralization, and business complexity were constructed using binary-coded governance disclosures. The empirical analysis employs descriptive statistics, correlation analysis, regression models, and moderation testing. The findings reveal substantial cross-market heterogeneity. In the Palestinian market, decentralization and business complexity are positively associated with governance effectiveness when examined independently, whereas the interaction effect is not supported. In the Jordanian market, business complexity emerges as the primary determinant of governance effectiveness, while decentralization shows no significant effect. Across both markets, the hypothesized moderating role of business complexity is not supported. The study contributes to the sustainable corporate governance literature by demonstrating that governance effectiveness in emerging markets is not merely a compliance issue, but also a sustainability-related organizational capability that supports transparency, accountability, institutional resilience, and responsible long-term decision-making. The findings provide context-sensitive implications for regulators and firms seeking to strengthen sustainable corporate governance practices within institutionally heterogeneous emerging-market environments. Full article

The knowledge economy and green innovation are fundamental pillars for the transition towards sustainable production models. The objective of this study was to analyze the influence of intellectual capital, green knowledge management and environmental practices on green innovation in SMEs in Tena. A quantitative cross-sectional approach was developed, applying a structured questionnaire to a sample of 64 green enterprises. Data analysis was performed using a Partial Least Squares Structural Equation Model (PLS-SEM), after evaluating the psychometric properties of the measurement model. The results show that the model explains 40% of the variance in green innovation. It was confirmed that Environmental and Technological Practices (ETPs) have the strongest and most significant effect on innovation, followed to a lesser extent by Intellectual Capital, whose influence was positive but marginal. Green Knowledge Management did not show a statistically significant impact. It is concluded that green innovation in Amazonian enterprises depends primarily on the adoption of technological infrastructure and tangible practices, while the systematization of knowledge remains a pending challenge. Full article

Background: Hypertension is one of the most common noncommunicable diseases. Objectives: This research assessed the magnitude of hypertension among young adults, identified its key determinants, and explored potential strategies adopted for prevention. Methods: A cross-sectional design was employed, including 1606 participants aged 18 years and older, recruited through convenience sampling from universities and community settings. Data were collected using a content-validated questionnaire covering sociodemographic information, personal and family medical history, and lifestyle habits. Results: Of the participants, 993 (61.8%) reported hypertension, nearly double previous national estimates. Male gender, age ≥ 30 years, and family history were significant risk factors, along with smoking, alcohol use, sedentary lifestyle, and unhealthy diet, while physical activity and dietary modification were protective. Despite high prevalence, only 22.1% had controlled blood pressure and 17.8% adhered to medication, with 51.5% relying on herbal remedies. Conclusions: These findings highlight the urgent need for early screening, youth-focused awareness, and culturally tailored interventions to reduce hypertension and prevent long-term cardiovascular complications. Hypertension among young adults in the UAE is a major public health concern, requiring integrated strategies combining education, lifestyle modification, and medical management to improve outcomes. Full article

Purpose: This study aimed to assess MRI-related claustrophobia severity and patient-reported experiences among Saudi patients to examine their associations with selected demographic variables. Methodology: A cross-sectional study was conducted using a structured questionnaire administered to 200 Saudi patients who had previously undergone MRI examinations. The questionnaire comprised five sections covering demographic data, phobia severity and patient-reported experiences before, during and after MRI examinations. Statistical analysis was performed using SPSS statistical package (IBM SPSS Statistics version 26, IBM Corp., Armonk, NY, USA), applying chi-square tests to examine associations between demographic variables and questionnaire responses. Results: A significant majority of participants, 76.5%, reported a positive MRI experience, whereas only 6.5% reported a negative experience. Shortness of breath during the MRI examination was the most frequently reported source of discomfort (75%). Significant associations were identified between demographic characteristics and phobia severity. Age and gender were significantly correlated with sudden fear responses, while educational level was strongly associated with receiving adequate pre-scan information and overall examination experience. Conclusions: Despite the high percentage of positive experiences, a notable proportion of participants reported anxiety-related distress during MRI examinations. The observed associations between demographic variables and claustrophobia-related responses suggest the potential value of patient-centred approaches, particularly improved pre-scan education, to improve the MRI-related patient experience and reduce anxiety-related distress. Full article

Background/Objectives: Respiratory syncytial virus (RSV) is the leading cause of infant hospitalizations in the United States. Prevention strategies are recommended to mitigate severe RSV outcomes. In addition to identifying potential coverage gaps, preventative administration timing is important for estimating product effectiveness. This study characterized administration timing of maternal and infant immunization against RSV across the United States during the 2024–2025 RSV season. Methods: A retrospective cross-sectional study was conducted using administrative claims of a commercially insured population from Kythera Labs. Pregnant individuals who received RSVpreF vaccine and infants who received nirsevimab were included. The seasonal cohort included infants born during the RSV season, while infants born from April to September were considered as the catch-up cohort. Baseline characteristics and calendar month and age at immunization (gestational age for RSVpreF) were evaluated. Results: Overall, 37,686 (71.9%) of maternal vaccinations were administered at 32–34 gestational weeks and 92.7% of all vaccinations occurred ≥14 days before delivery. Among infants who received nirsevimab, 34.8% of the seasonal cohort were immunized within 1 week of birth and 33.4% of the catch-up cohort were immunized in October 2024. Conclusions: Most maternal RSVpreF vaccinations occurred early in the recommended eligible gestational age window, while only approximately one-third of infants received nirsevimab during the first week of life or at the beginning of the RSV season. These findings highlight the importance of timely administration of RSV preventives. They further demonstrate that immunization timing should be incorporated into evaluation of the effectiveness and population level impact of RSV prevention programs. Full article

Background: During the firing stage of artisanal brick production, particulate matter and other pollutants are released into the air, to which children are particularly vulnerable. Objective: To compare the frequency of allergic diseases and impaired lung function among children exposed and unexposed to artisanal brick production. Methods: A cross-sectional comparative study was conducted among 386 children aged 6 to 14 years, recruited from a primary and a secondary school in Guanajuato, Mexico. Participants were classified as exposed (n = 193) or unexposed (n = 193) to artisanal brick production. Once parents and children voluntarily consented to participate, study procedures were initiated. Forced spirometry and anthropometric measurements were performed, and the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was administered. We assessed the frequency of respiratory symptoms, allergic diseases, and lung function abnormalities. We measured the frequency of respiratory symptoms, allergic diseases, and lung function abnormalities. Results: The mean age of the 386 children was 9.7 ± 1.7 years. Each group consisted of 103 girls and 90 boys. The most important risk factors for impaired lung function were living in the brickyard (OR = 6.9, 95% CI: 4.3–11.1; p = 0.001) and being male (OR = 3.6, 95% CI: 2.3–5.7; p = 0.001). The prevalence of impaired lung function was 13.5% in exposed and 4.1% in unexposed children (OR = 3.6, 95% CI: 1.5–8.1; p = 0.001). Most of the respiratory symptoms observed were obstructive and we found no difference in the frequency of allergic diseases, but respiratory symptoms were more frequent in exposed children. Conclusions: Respiratory symptoms and obstructive abnormalities in pulmonary function are more prevalent among children living in brickyards. Male sex and residence in the brickyard were the principal risk factors for impaired lung function. Full article

Controlling deposition parameters is fundamental to obtaining the desired properties of cathodic arc physical vapor deposition (PVD) coatings. Achieving uniform coatings on tools with complex, sharp geometries remains a significant challenge due to localized ion flux concentration. Pulsing the substrate bias is an effective way of controlling deposition energy. However, while widely used in cathodic arc PVD, the relationship between the actual bias waveform, coating integrity on sharp tool geometries, and resulting machining performance has not been systematically established. This study investigates the effect of pulsed bias duty cycle (20% to 90%) and frequency (1 to 20 kHz) on the microstructural evolution, residual stress state, and machining performance of AlTiN coated tools. Real-time oscilloscope measurements demonstrated that system inductance and capacitance significantly distort the ideal bias waveform. Microstructural analysis via Focused Ion Beam/Scanning Electron Microscopy (FIB/SEM) cross-sectioning confirmed that all bias parameters generated a dense microstructure. While pulse frequency had no significant influence on micromechanical properties or residual stress states, the duty cycle was the dominant variable. High-energy deposition (90% duty cycle) increased hardness to 33.9 GPa but generated severe compressive residual stresses (−5.2 GPa). This extreme compressive stress led to catastrophic edge delamination on sharp solid carbide endmills. Conversely, a low-energy 20% duty cycle generated a coating with lower hardness (29.4 GPa) and a near-neutral stress state (0.5 GPa), effectively preserving the edge integrity. Unlike the endmills, the turning inserts maintained their edge integrity across all deposition conditions. During the high-speed (350 m/min) dry turning of AISI 304 stainless steel, all evaluated coatings exhibited comparable tool life and cutting forces. Wear progression was characterized by rake cratering, combined with abrasion and adhesion-induced attrition on the flank. The results indicate that tool life in this extreme environment is governed primarily by high-temperature thermo-chemical stability rather than initial room-temperature hardness. Lower-energy pulsed bias deposition therefore represents a robust strategy for coating a wide range of tool geometries, delivering equivalent high-speed machining performance while preventing stress-induced delamination on sharp features. Full article

Background/Objectives: Hand, foot and mouth disease (HFMD) has recently emerged as a serious health threat, as certain serotypes can cause severe illness. Serotype distribution vary by region, and seroprevalence studies helps in developing preventive strategies. This study aimed to determine the seroprevalence of enterovirus type 71 (EV-A71), Coxsackievirus A16 (CV-A16), Coxsackievirus A10 (CV-A10), and Coxsackievirus A6 (CV-A6), the main causative agents of HFMD and to investigate risk factors for seropositivity. Methods: This multicenter, cross-sectional study was conducted across five major cities in Türkiye. Children (6 months–17 years) who presented to outpatient clinics for any reason were included between May 2024 and January 2025. Neutralizing antibodies were measured using a microneutralization assay. Statistical analyses included descriptive methods, appropriate group comparisons (Chi-square/Fisher’s Exact), and backward logistic regression to identify factors associated with HFMD seropositivity. Results: The study included 998 participants (mean age: 8.6 ± 5.2 years; 51.3% male). CV-A6 antibodies were detected in 68.5%, EV-A71 in 66.5%, CV-A10 in 60.2%, and CV-A16 in 46.0% of samples. No viral antibodies were detected in 5.3% of serum samples (All-Negative group); antibodies against at least one HFMD agent were detected in 94.7% (Any-Positive group). HFMD seropositivity increased significantly with age. Handwashing habits did not differ between the groups. The any-positive group more often had a household member aged 12–18 years, a mother with lower education, and higher kindergarten attendance. In logistic regression analysis, age, average monthly household income, and mother’s education level were the factors influencing seropositivity. Conclusions: The seroprevalence of HFMD-causing viruses in Türkiye is high from six months of age onward. Beyond promoting personal protective measures, the implementation of a vaccination program should also be considered. Full article

Maternal folate receptor alpha autoantibodies (FRAA) have been associated with impaired placental folate transport, fetal cerebral folate deficiency (CFD) and neurodevelopmental risks including autism spectrum disorder (ASD); however, first-trimester-specific reference intervals remain undefined. This prospective single-center study of 534 healthy pregnant women at 10 + 0 to 15 + 6 weeks’ gestation (week 10 n = 26; week 11 n = 155; week 12 n = 203; week 13 n = 105; week 14 n = 39; week 15 n = 6) used a CE-IVDR FRAA ELISA, following CLSI EP28-A3c and IFCC C-RIDL protocols, to establish week-specific percentiles (P5, P50, P95, P99) via non-parametric estimation and log-smoothed regression with a 1-week rolling window. An internal-consistency ROC analysis was performed against the within-dataset ≥P99 designation and is therefore not interpretable as discrimination against an independent clinical outcome. Median FRAA declined from 29 ng/mL (week 10) to 25 ng/mL (week 14), with provisional clinically actionable thresholds of P95 ≈ 120 ng/mL and P99 ≈ 150 ng/mL. These data provide the first first-trimester normative percentile curves for maternal FRAA and may support prioritizing FRAA assessment before 15 weeks (onset of accelerated transplacental IgG transfer). Given the cross-sectional, single-center design, the small samples at weeks 14–15, and the absence of long-term neurodevelopmental outcome data, the proposed thresholds and any downstream clinical implications, including folinic acid intervention and ASD risk mitigation, should be considered hypothesis-generating and require external and longitudinal validation. Full article