Search Results (1,135)

Background: Quality care of individuals with sickle cell disease (SCD) is dependent upon education of the providers on their care team. Previous studies demonstrate lack of resident and provider comfort regarding care of patients with SCD, yet none have assessed these in medical students. Objective: This study aims to evaluate the adequacy of the research instrument for measuring medical students’ knowledge, confidence, and comfort regarding SCD and related complications prior to wider distribution. Methods: A self-assessment survey was distributed to medical students at two universities to evaluate their knowledge, confidence, and comfort in general SCD topics, in all clinical settings, and regarding common complications. Results: Of the 98 responses, knowledge (p < 0.001) and confidence (p = 0.02) were significantly different between topics, including epidemiology and genetics, pathophysiology, and treatment options. For “treatment options”, there were significant differences in knowledge (p = 0.02) and confidence (p = 0.02) between medical students at different levels of training. Students felt least knowledgeable and least comfortable with care of pregnant women and most knowledgeable and most comfortable with acute pain management. Caring for patients with specific SCD-related conditions increased knowledge and comfort across all domains. Conclusions: This instrument was adequate for measuring knowledge, confidence, and comfort in caring for those with SCD across all clinical settings. We identified a lack of knowledge, confidence, and comfort regarding treatment for those with SCD starting early in medical careers, which improves after caring for patients with various complications. Thus, educating and providing SCD patient experiences is crucial for medical student management confidence related to SCD. Full article

The COVID-19 pandemic precipitated unprecedented social isolation measures, profoundly disrupting daily life, educational routines, and mental health worldwide. University students, already susceptible to psychological distress, encountered intensified challenges under remote learning and prolonged confinement. This longitudinal study examined fluctuations in anxiety and mood among 102 Brazilian university students during the pandemic, distinguishing between those solely engaged in academic pursuits and those simultaneously balancing work and study. Data collected via the Brunel Mood Scale and State-Trait Anxiety Inventory in April and July 2021 revealed that students exclusively focused on studies exhibited significant increases in depressive symptoms, anger, confusion, and anxiety, alongside diminished vigor. Conversely, participants who combined work and study reported reduced tension, fatigue, confusion, and overall mood disturbance, coupled with heightened vigor across the same period. Notably, women demonstrated greater vulnerability to anxiety and mood fluctuations, with socioeconomic disparities particularly pronounced among females managing dual roles, who reported lower family income. These findings suggest that occupational engagement may serve as a protective factor against psychological distress during crises, underscoring the urgent need for tailored mental health interventions and institutional support to mitigate the enduring impacts of pandemic-related adversities on the student population. Full article

In an era where digitalization shapes economic and social landscapes, the intersection of digital skills, ethics, and integrity plays a crucial role in understanding the vulnerability of youth classified as NEET (Not in Education, Employment, or Training). This study explores how risky internet use and digital skill gaps contribute to socio-economic exclusion, integrating a multivariate and spatial approach to assess regional disparities in Europe. This study adopts a systems thinking perspective to explore digital exclusion as an emergent outcome of multiple interrelated subsystems. The research employs logistic regression, Principal Component Analysis (PCA) with Promax rotation, and Geographic Information Systems (GIS) to examine the impact of digital behaviors on NEET status. Using Eurostat data aggregated at the country level for the period (2000–2023) across 28 European countries, this study evaluates 24 digital indicators covering social media usage, instant messaging, daily internet access, data protection awareness, and digital literacy levels. The findings reveal that low digital skills significantly increase the likelihood of being NEET, while excessive social media and internet use show mixed effects depending on socio-economic context. A strong negative correlation between digital security practices and NEET status suggests that youths with a higher awareness of online risks are less prone to socio-economic exclusion. The GIS analysis highlights regional disparities, where countries with limited digital access and lower literacy levels exhibit higher NEET rates. Digital exclusion is not merely a technological issue but a multidimensional socio-economic challenge. To reduce the NEET rate, policies must focus on enhancing digital skills, fostering online security awareness, and addressing regional disparities. Integrating GIS methods allows for the identification of territorial clusters with heightened digital vulnerabilities, guiding targeted interventions for improving youth employability in the digital economy. Full article

This article describes the design, methods, and baseline characteristics of the social needs assessment (SNA) of participants enrolled in an ongoing randomized clinical trial implementing a comprehensive approach to improving diabetes self-management and providing an intensive Diabetes Self-Management Education and Support (iDSMES) Program at St. Vincent’s House Clinic, a primary care practice serving resource-challenged diverse populations in Galveston, Texas. Standardized SNA was conducted to collect information on financial needs, psychosocial well-being, and other chronic health conditions. Based on their identified needs, participants were referred to non-medical existing community resources. A series of in-depth interviews were conducted with a subset of participants. A team member independently categorized these SNA narratives and aggregated them into two overarching groups: medical and social needs. Fifty-nine participants (with a mean age of 53 years and equal representation of men and women) completed an SNA. Most (71%) did not have health insurance. Among 12 potential social needs surveyed, the most frequently requested resources were occupational therapy (78%), utility assistance (73%), and food pantry services (71%). SNA provided data with the potential to address barriers that may hinder participation, retention, and outcomes in diabetes self-management. SNA findings may serve as tertiary prevention to mitigate diabetes-related complications and disparities. Full article

This entry explores the multifaceted intersections of gender and digital technologies, offering a comprehensive analysis of how structural inequalities are reproduced, contested, and transformed in digital contexts. It is structured into six interrelated sections that collectively address key dimensions of gendered digital contexts. It begins by addressing the gender digital divide, particularly in the Global South, emphasizing disparities in access, literacy, and sociocultural constraints. The second section examines gendered labor in the tech industry, highlighting persistent inequalities in Science, Technology, Engineering, and Mathematics (STEM) education, employment, and platform-based work. The third part focuses on gender representation in digital spaces, revealing how algorithmic and platform design perpetuate biases. The fourth section discusses gender bias in AI and disinformation, underscoring the systemic nature of digital inequalities. This is followed by an analysis of online gender-based violence, particularly its impact on marginalized communities and participation in digital life. The final section considers the potentials and limitations of digital activism in advancing gender justice. These sections collectively argue for an intersectional, inclusive, and justice-oriented approach to technology policy and design, calling for coordinated global efforts to create equitable digital futures. Full article

Regional shrinkage, driven by declining birth rates, an aging population, and population concentration in the capital region, has become an increasingly serious issue in South Korea, threatening the long-term sustainability of local communities. Among various factors, youth out-migration is a key driver, undermining the economic resilience and vitality of local areas. This study aims to predict youth population trends across 229 municipalities by incorporating diverse regional socioeconomic factors and providing a foundation for policy implementation to mitigate demographic disparities. To this end, a long short-term memory (LSTM) model, based on a direct approach that independently forecasts each future time point, was employed. The model was trained using the youth population data from 2003 to 2022 and socioeconomic variables, including employment, education, housing, and infrastructure. The results reveal a persistent nationwide decline in the youth population, with significantly sharper decreases in local areas than in the capital region. These findings underscore the deepening spatial imbalance and highlight the urgent need for region-specific demographic policies to address the accelerating risk of regional population decline. Full article

Background: Prematurity and low birth weight (LBW) drive infant morbidity and mortality, requiring nutritional interventions, especially in food-insecure settings. In Indonesia, regional disparities in food security hinder adequate nutrition for premature and LBW infants, exacerbating health challenges. The aim of study is to investigate and determine factors associated with prematurity and LBW in children from food-insecure and food-secure households. Methods: This research employed a cross-sectional study with 657 mothers of children aged 36–59 months, conducted using random sampling. Data was collected via standardized questionnaires and analyzed using Chi-square tests and logistic regression. Results: The adjusted model showed that children of food-insecure households had a higher risk of LBW (AOR = 0.54; 95% CI: 0.29–0.99; p < 0.05). LBWs were found to significantly less occur in food-insecure households. Low maternal education was associated with an increased risk of preterm birth (AOR = 3.23; 95% CI:1.78–5.84; p < 0.001). Furthermore, prematurity correlated with house ownership (p < 0.01), indicating the household’s wealth condition. Maternal education and house ownership were linked to prematurity, indicating the risk to child health outcomes. In summary, maternal education, employment status, and household income were linked to food insecurity, indicating the risk to child health outcomes. Conclusion: Strategies to improve child health outcomes are essential, including enhancing maternal nutrition knowledge to improve child feeding practices, promoting gender equality in career development, and reducing food insecurity in households. Full article

Improving curriculum structure is critical for enhancing student success and on-time graduation, yet few methods exist to evaluate how prerequisite paths shape student progression and graduation outcomes. This study proposes a data-driven, graph-based framework that integrates course prerequisite networks with student performance data to systematically analyze curricular structure and student outcomes. We identify high-risk courses by jointly modeling their structural importance and pass rates, and quantify the time and survivability of different prerequisite paths using probabilistic models. Additionally, we introduced grade transition patterns to capture more nuanced transitions in student performance and pinpoint bottlenecks along prerequisite paths. Applying the model on four science and engineering majors from a public institution, the results not only identify high-risk courses often missed in conventional analyses, but also reveal path-level disparities and structural bottlenecks that affect student progression and time to graduation. For example, in the Computer Science major, we identified that the architecture and operating systems pathway is more challenging than the software engineering pathway. A closer examination of the course pairs along this trajectory revealed that the difficulty stems from a significant drop in student performance between a prerequisite–successor course pairs.This type of analysis fills a gap in conventional curriculum studies, which often overlook path-level dynamics, and offers actionable insights for educators a to identify high risk curricular components. Full article

This research aims to examine the role and emerging trends of critical thinking within tertiary education through a bibliometric analysis, with particular emphasis on disparities among countries with differing Human Development Index (HDI) levels. The analysis seeks to identify thematic associations related to critical thinking across nations at various stages of development, as well as to explore the educational methods and strategies employed regionally to cultivate critical thinking skills. The findings highlight notable contrasts between developed and developing nations, especially in terms of educational strategies, dominant academic discourses, and region-specific research priorities. Full article

Introduction: Adolescents and young adults (AYAs), especially those from underserved communities, often face barriers to sexual and reproductive health (SRH). This pilot study evaluated the implementation of mobile health technologies to promote SRH care, including the integration of the Rapid Adolescent Prevention Screening^TM (RAAPS) and the Health-E You/Salud iTu^TM (Health-E You) app at a School-Based Health Center (SBHC) in Los Angeles using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Methods: This multi-method pilot study included the implementation of an integrated tool with two components, the RAAPS electronic health screening tool and the Health-E You app, which delivers tailored SRH education and contraceptive decision support to patients (who were sex-assigned as female at birth) and provides an electronic summary to clinicians to better prepare them for the visit with their patient. Quantitative data on tool usage were collected directly from the back-end data storage for the apps, and qualitative data were obtained through semi-structured interviews and in-clinic observations. Thematic analysis was conducted to identify implementation barriers and facilitators. Results: Between April 2024 and June 2024, 60 unique patients (14–19 years of age) had a healthcare visit. Of these, 35.00% used the integrated RAAPS/Health-E You app, and 88.33% completed the Health-E You app only. All five clinic staff were interviewed and expressed that they valued the tools for their educational impact, noting that they enhanced SRH discussions and helped uncover sensitive information that students might not disclose face-to-face. However, the tools affected clinic workflows and caused rooming delays due to the time-intensive setup process and lack of integration with the clinic’s primary electronic medical record system. In addition, they also reported that the time to complete the screener and app within the context of a 30-min appointment limited the time available for direct patient care. Additionally, staff reported that some students struggled with the two-step process and did not complete all components of the tool. Despite these challenges, clinic staff strongly supported renewing the RAAPS license and continued use of the Health-E You app, emphasizing the platform’s potential for improving SRH care and its educational value. Conclusions: The integrated RAAPS and Health-E You app platform demonstrated educational value and improved SRH care but faced operational and technical barriers in implementing the tool. These findings emphasize the potential of such tools to address SRH disparities among vulnerable AYAs while providing a framework for future implementations in SBHCs. Full article

This study explores digital inequality as a socio-spatial phenomenon within the context of smart inclusion, focusing on the Regional Unit of Xanthi, Greece—a region marked by ethno-cultural diversity and pronounced urban–rural contrasts. Using a mixed-methods design, this research integrates secondary quantitative data with qualitative insights from semi-structured interviews, aiming to uncover how spatial, demographic, and cultural variables shape digital engagement. Geographic Information System (GIS) tools are employed to map disparities in internet access and ICT infrastructure, revealing significant gaps linked to geography, education, and economic status. The findings demonstrate that digital inequality is particularly acute in rural, minority, and economically marginalized communities, where limited infrastructure intersects with low digital literacy and socio-economic disadvantage. Interview data further illuminate how residents navigate exclusion, emphasizing generational divides, perceptions of technology, and place-based constraints. By bridging spatial analysis with lived experience, this study advances the conceptualization of digitally inclusive smart regions. It offers policy-relevant insights into how territorial inequality undermines the goals of smart development and proposes context-sensitive interventions to promote equitable digital participation. The case of Xanthi underscores the importance of integrating spatial justice into smart city and regional planning agendas. Full article

More than 50 years ago, children were viewed as naturally resilient and often labeled invulnerable or invincible. Resilience is now understood to be the result of dynamic interactions between individual, familial, social, and environmental systems, decentralizing the focus from the individual to the global society. Experiences with adversity may emanate from the youth’s family environment, their community, the school system, and larger structural challenges related to poverty, discrimination, health disparities, and educational inequities. Youth experiences with adversity, trauma, and tragedy have the potential to negatively impact youth well-being, with consequences manifesting across the lifespan. Children and adolescents generally hold limited power to change their circumstances and are often ill-equipped to resolve the adverse or traumatic experiences occurring within their ecosystem. The value of social supports in the young person’s ability to be resilient has been affirmed. This understanding is particularly important for children growing up in poverty or in Low- and Middle-Income Countries (LMICs) where significant challenges occur as a result of economic and social disadvantage. Resilience at the individual level is unlikely to eliminate macrolevel issues. Developing and deploying strategies to enhance the ability of youth to rebound from adversity represents a positive step at the micro level, but the larger issues of economic and social disadvantage are unlikely to change without macro-level interventions. Glancing toward the future, traumatized youth may grow into traumatized adults without appropriate interventions and changes in social policies, programs, and protections. Full article

Background/Objectives: The field of dietary supplements is changing and evolving quickly. Registered Dietitian Nutritionists are recognized as experts in nutrition and familiarity with the usage of dietary supplements is expected. However, education on the use of dietary supplements is not equal across accredited dietetic education programs, which can lead to disparities in dietitians’ feelings of preparedness, attitudes, and consequently experience of comfort regarding dietary supplements. The purpose of this study was to create the D-SCOPE Questionnaire (Dietitians’ Survey of Comfort, Opinions, and Preparedness in Education in Supplements) and validate it. This questionnaire assesses Registered Dietitian Nutritionists’ feelings of preparedness, comfort with use, and general attitudes in the field of dietary supplements. Methods: Face and content validity was established with dietitian, nutritionist, and statistician input. For recruitment, 2000 national randomly selected emails were obtained from the Commission on Dietetic Registration. Registered Dietitian Nutritionists (n = 248) responded to the survey email request. Descriptive statistics (reported as means ± standard deviation), principal axis factoring (exploratory factor analysis) with a direct oblimin rotation and Cronbach’s a reliability analysis were used for validation techniques. Results: Five factors were created, which explained about 63% of the variance in the questionnaire. The questionnaire was generally reliable, but the factor structure could change with a non-US population. Conclusions: As a unit, the D-SCOPE Questionnaire shows validity and reliability in assessing Registered Dietitian Nutritionists’ perceptions of preparedness and attitudes in the area related to dietary supplements. Full article

Introduction: Dental caries and molar–incisor hypomineralisation (MIH) are prevalent conditions affecting children’s oral health, with functional, aesthetic, and psychosocial implications. In Spain, previous studies have highlighted geographic and sociodemographic disparities in their distribution, particularly among rural and migrant populations. Objective: To characterise oral health status, in terms of caries and MIH, among 6–7-year-old children from the towns of Palos de la Frontera, Mazagón, and San Bartolomé. Methods: A cross-sectional study was conducted involving 229 children recruited from public primary schools. Sociodemographic, anthropometric, and behavioural data were collected through clinical examination and interview. Statistical analysis included univariate and multivariate logistic regression. The study protocol was approved by the Ethics Committee of Huelva. Results: The prevalence of caries (DMFT ≥ 1) was 53.3%, with mean DMFT and dft indices of 1.78 and 0.31, respectively. MIH affected 32.8% of the cohort, with a predominance in the first permanent molars (teeth 36 and 26). Multivariate analysis identified independent predictors of caries: African (OR = 7.47; 95% CI: 2.84–23.8) and European (OR = 4.56; 95% CI: 1.26–22.3) parental origin, poor oral hygiene (OR = 3.07; 95% CI: 1.60–6.03), and the presence of MIH (OR = 3.20; 95% CI: 1.64–6.42). The municipality of San Bartolomé was associated with a higher risk of MIH (OR = 2.90; 95% CI: 1.21–7.45). Conclusions: The high prevalence of caries and MIH in the Condado-Campiña district, exceeding national averages, reflects oral health inequities linked to social determinants (migrant origin, locality) and clinical factors (MIH, oral hygiene). Targeted preventive interventions are urgently needed in high-risk populations, including culturally tailored education and policies ensuring equitable access to dental care services. Full article

Background and Objectives: Gender disparities in pain management persist, with women frequently receiving inadequate analgesia despite reporting similar or higher pain levels compared with men. This issue is particularly evident across various medical and gynecological procedures. Materials and Methods: This integrative literature review synthesizes recent empirical studies examining gender biases in pain perception and management, focusing specifically on procedural pain in women. It includes an analysis of clinical research, patient-reported outcomes, and healthcare provider behaviors. Results: The findings indicate that unconscious biases, a lack of gender-specific clinical protocols, and prevailing cultural stereotypes contribute to the undertreatment of pain in women during procedures such as intrauterine device insertion and diagnostic hysteroscopy. Additionally, communication gaps between patients and healthcare providers exacerbate these disparities. Conclusions: Addressing gender disparities in pain management necessitates systemic reforms, including the implementation of gender-sensitive clinical guidelines, enhanced provider education, and targeted policy changes. Personalized, gender-informed approaches are essential to improving equity and quality of care in pain treatment. Full article