Search Results (5,188)

Background: Nutrition problems among primary school children increase the risk of illness, reduce school attendance, and impair academic performance. The Indonesian national school feeding program (ProGAS—Program Gizi Anak Sekolah) was developed to address these issues through the provision of healthy breakfast, nutrition education, and character building. Methods: This study employed a mixed-methods design involving 454 primary school students aged 8–14 years from 24 schools across four provinces. Data collection included structured questionnaires, 24 h dietary recalls, and anthropometric measurements. In-depth interviews with school principals, teachers, cooking teams, parents, students, nutritionists, and district education office staff were conducted to capture experiences and opinions on the ProGAS implementation. Results: ProGAS significantly improved students’ dietary diversity, meal frequency, handwashing with soap, and nutrition knowledge, alongside a positive trend in school attendance. Improvements included higher mean dietary diversity, increased proportion of students eating ≥3 meals/day, greater correct responses on balanced nutrition, and higher rates of handwashing before meals (all p < 0.01). Children also developed positive behaviors such as praying before meals, queuing, and taking responsibility for cleaning dishes. However, students’ breakfast habits did not significantly improve, the delivery of nutrition education was suboptimal, and no significant changes were observed in nutrient intakes or nutritional status based on BMI-for-age. While the energy and protein contributions of the ProGAS menu met the recommended 25–30% of daily requirements for breakfast, its micronutrient contributions remained below the recommended levels. Key management gaps include the delivery of nutrition education to students and the monitoring of implementation by local and national authorities. Conclusions: ProGAS demonstrated positive impacts on some dietary and hygiene practices as well as learning environment. To achieve greater improvements in breakfast habits, nutrient intake and nutritional status, it is recommended to strengthen the school feeding menus not only for dietary diversity but also for nutrient density, enhance capacity building for teachers, deliver regular and engaging nutrition education, and reinforce program monitoring. Full article

Background: Mental health conditions are a growing public health concern among U.S. adolescents, particularly high school students. Emerging data show a strong link between exposure to neighborhood violence and increased risk of poor mental health outcomes, such as depression, anxiety, and persistent sadness. Objective: This study examined the relationship between neighborhood violence exposure and mental health outcomes among high school students. Method: This is a cross-sectional study using the 2023 Youth Risk Behavior Survey. The sample included 19,910 students in grades 9–12 across gender and race. Mental health status and exposure to neighborhood violence were analyzed using chi-square tests and logistic regression models. Results: Students exposed to neighborhood violence had significantly higher odds of reporting poor mental health outcomes (AOR = 1.789, 95% CI: 1.573–2.035, p < 0.001) than the unexposed. Additionally, female, Hispanic/Latino, and multiracial students reported higher rates of mental health disorders than the male students. Conclusions: Neighborhood violence exposure was significantly associated with poor mental health outcomes among high school students. These findings signify the need for targeted interventions to support affected students and reduce neighborhood violence exposure, particularly in marginalized communities. The findings will inform public health professionals, educators, and policymakers to make targeted school-based mental health interventions and community-centered policies addressing neighborhood safety and adolescent mental health. Full article

Background: Previous longitudinal evidence suggested that screen exposure at age 4 was associated with dysregulation symptoms and lower academic achievement up to age 8. Yet, it remains unclear whether these effects persist in preadolescence and extend to higher-order developmental outcomes such as the capacity to be alone, a marker of self-regulation and autonomy within the developmental psychopathology framework. Aim: This follow-up study re-contacted the original cohort at age 12 (T3) to examine whether early screen time predicted dysregulation, academic achievement, and capacity to be alone, testing the mediating role of dysregulation at ages 6 (T1) and 8 (T2), and the moderating role of maternal scaffolding at age 4. Methods: A community sample of N = 323 children and their mothers, previously assessed at T0–T2, was re-evaluated at T3 (mean age = 12.2 years, SD = 0.7). At T0, screen exposure and maternal scaffolding were measured using the StimQ (PIDA subscale). Dysregulation at T1–T3 was assessed with the Teacher Report Form (TRF). Academic achievement in mathematics and literacy was rated by teachers using the Teacher Academic Ratings. At T3, children also completed the Capacity to Be Alone Scale for Children (CBASC). Structural Equation Modeling (SEM) tested longitudinal direct, indirect, and moderated pathways, adjusting for sex, maternal education, and socioeconomic status. Results: Screen time at age 4 was associated with elevated dysregulation at T1 and T2, which in turn mediated poorer mathematics and literacy outcomes and reduced capacity to be alone at age 12 (all p < 0.01). Maternal scaffolding buffered early dysregulation but did not prevent long-term academic or self-regulatory impairments. Conclusions: Findings indicate that early excessive screen use contributes to a cumulative cascade of dysregulation, undermining both academic achievement and the developmental capacity to be alone by preadolescence. Preventive strategies should integrate screen-time guidelines with parental scaffolding interventions. Full article

Background: Healthy aging involves ensuring a good quality of life and maintaining autonomy. Physical performance is a key indicator of health and autonomy in old age, and it is influenced by social determinants of health. The aim of this study was to evaluate differences in physical performance and geriatric health outcomes among older adults attending a community center, according to their educational level, pension status, and access to health services. Methods: An observational, descriptive, retrospective and cross-sectional study was carried out using the database of subjects aged 60 and over who attend a community gerontological center. Results: A total of 536 older adults (mean age 70.7 ± 8.4 years, 71.5% women, 86.9% with public health coverage) with an average age of 70.7 ± 8.4 years were included; subjects with higher education had higher weight, as well as better indicators of physical functionality: higher scores in the Barthel and Lawton–Brody indices, greater walking speed, less time in the test to get up from the chair and in the test “Time Up and Go” (TUG), and increased prehensile strength. Conclusion: Social determinants, including education, economic independence, health coverage, and pension status, significantly influence physical performance and geriatric syndromes in older adults. Full article

Background/Objectives: Stress during pregnancy critically impacts maternal and fetal health. While prior research has linked sociodemographic and biological factors to stress levels, the role of specific biomarkers, such as vitamin D (VD), remains unexplored. This study examined the relationships among sociodemographic factors, VD status (as measured by serum 25-hydroxyvitamin D [25(OH)D] concentration), and perceived stress in pregnant women. We hypothesized that 25(OH)D concentration would be associated with perceived stress levels during pregnancy. Methods: A post hoc analysis of the Kellogg Pregnancy VD study was conducted on a cohort of 232 pregnant women with Perceived Stress Scale (PSS-10) scores at months 2, 5, and 7 with corresponding 25(OH)D concentrations. PSS-10 scores were classified into two groups: patients with scores of 0–13 were considered to have low stress, while those with scores of 14–40 were considered to have moderate-to-high stress. Logistic regression models identified factors associated with moderate-to-high stress. Results: At month 2, univariate analyses showed that being married (p = 0.002), having a college education (p = 0.0013), and lower BMI (p = 0.018) were associated with lower perceived stress, whereas Black race was associated with higher perceived stress (p = 0.027). By month 7, higher serum 25(OH)D concentration was the only significant predictor of perceived stress in univariate analysis (p = 0.002). In multivariate models at month 7, 25(OH)D approached significance (p = 0.053). Conclusions: Early in pregnancy, race, marital status, college education, and BMI were significantly associated with PSS-10 score. By month 7, 25(OH)D concentration over time emerged as a factor that was significantly associated in univariate analysis and showed a trend toward significance in multivariate models. VD status, as measured by 25(OH)D concentration, may act as a biomarker of stress during pregnancy. Results warrant further study in prospective intervention trials. Full article

Household waste systems are a frontline test of Australia’s circular economy transition, yet progress remains highly uneven and structurally constrained. Despite strong national targets for resource recovery and emissions reduction, local governments are expected to deliver circular outcomes without uniform access to infrastructure, funding, or technical capability. This study assesses the status, implementation, and progress of household waste management, energy recovery, and circular economy initiatives at the local government level in Australia. Using content analysis of data from 520 local government areas across six states, the study maps differences in service provision (e.g., general waste, mixed recycling, and food organics and garden organics [FOGO] collection), policy instruments, public-facing education, and participation in circular economy programs. The findings reveal that while a majority (92.5%) of councils provide general waste bins, 47% offer FOGO bins, and 78% supply mixed recyclable bins, only a small fraction (2.6%) offers a separate glass bin stream. Fewer than one in ten councils reference any form of energy recovery or waste-to-energy initiative, indicating that resource–energy integration remains emergent and geographically concentrated. Despite national policies such as the National Waste Policy Action Plan, significant regional disparities persist, particularly between metropolitan and rural councils. Guided by environmental governance theory and systems thinking, the study shows how policy fragmentation, funding limitations, and infrastructure inequities create systemic barriers to circularity. The study concludes by recommending targeted co-funding for rural councils, stronger policy support for organics and energy recovery infrastructure, and more coherent multi-level governance to achieve Australia’s 2030 waste and circular economy targets. This research contributes an evidence-based framework for understanding how governance structures and resource asymmetries shape local progress toward a circular economy. Full article

Women with disabilities often face unique barriers to accessing healthcare, potentially increasing their vulnerability and reducing engagement with vital health services, including human immunodeficiency virus (HIV) testing. This study assessed the prevalence and associated factors of HIV-testing among women with disabilities in Ghana. Cross-sectional data from the 2017–2018 Ghana Multiple Indicator Cluster Survey, encompassing 819 women with disabilities, were analysed both descriptively and inferentially. The overall prevalence of HIV testing was 48.0% (95%CI = 44.6–51.4). Educational attainment, marital status, and geographical region were key determinants of HIV testing uptake. Women possessing a Senior High School or Tertiary level education demonstrated higher odds of HIV testing compared to those with no formal education. Women residing in Greater Accra, Volta, Brong Ahafo, and Upper West regions were more likely to have undergone HIV testing than those in the Western Region. Never-married women exhibited lower odds of HIV testing uptake than their married counterparts. No statistically significant association was found between various disability types and HIV testing uptake. Less than half of women with disabilities in Ghana had ever tested for HIV, highlighting a substantial unmet need and underscoring the urgent need for targeted interventions, including enhanced, region-specific educational and health promotion initiatives, and tailored support for never-married women with disabilities. Full article

Background/Objectives: Long-term follow up of pediatric radiotherapy survivors referred to tertiary and quaternary centers is difficult, limiting outcome monitoring. We implemented an electronic Health Status Survey (HSS) to capture survivorship data. Methods: The Health Status Survey (HSS) was distributed to survivors aged 1 month–25 years treated with curative-intent radiotherapy at our institution. Eligibility required confirmed survival and valid email contact. Survey responses and demographics were summarized with descriptive statistics and comparative tests. Surveys were sent to 876 eligible participants, with 322 responses received (36.8%) between December 2023 and March 2024. Results: Survey completion extended follow up by a median of 18.3 months (about 1.5 years), improving monitoring beyond the last chart-documented visit. Respondents reported 12 recurrences, 5 s malignancies, and 7 deaths not captured in prior records, altering event-free survival statistics by as much as 7.5%. Most respondents (90.1%) reported a medical visit in the past year, and many provided updates on ongoing health issues, provider contact, and social outcomes. Conclusions: The HSS is a replicable method for extended follow up of tertiary and quaternary care center patients, capturing previously unreported clinical, social, and educational outcomes. By supplementing chart data with patient-reported information, this cost-effective tool supports targeted annual follow up and the identification of trends for long-term survivorship care. Full article

This article examines intergenerational social mobility as a driver of sustainable development on the case of Lithuania, a country in Eastern Europe. Using data from the European Social Survey (2020), the analysis explores how parental education and occupation shape individual educational and occupational outcomes. Descriptive, correlational, and regression analyses reveal that while structural mobility has been facilitated by Lithuania’s transition from Soviet rule to a market economy and subsequent European integration, family background remains a decisive factor. The study also highlights the key factors that promote or constrain social mobility in contemporary Lithuania. The interaction between mothers’ and fathers’ education fosters the attainment of higher levels of education, whereas mothers’ occupational status and respondents’ gender (male) appear to limit it. Similarly, the achievement of a higher occupational level is positively influenced by the interaction between parental education and the respondent’s own highest educational attainment, while negatively influenced by gender. These findings demonstrate that education not only determines social mobility but also supports the broader objectives of sustainable development by reducing inequality, fostering human capital, and advancing gender equality. The results underscore the importance of inclusive social policies that ensure equitable access to quality education and align educational opportunities with labor market demands, thereby reinforcing social mobility as a foundation for long-term social resilience and sustainability. Full article

Background: Dietary fiber plays a crucial role in body weight regulation and metabolic health. Despite benefits, fiber intake remains suboptimal. This study investigated the relationship between dietary fiber intake, BMI, and fiber sources among young Austrian adults in higher education. Methods: A cross-sectional study was conducted using a validated screening tool (18-item FiberScreen) to assess total daily fiber intake. Self-reported anthropometric data were used to calculate BMI, and participants were categorized into normal-weight and overweight groups. Differences in fiber intake and sources were analyzed by sex and BMI category. Correlations between fiber intake, BMI, and food group contributions were assessed. Results: The mean daily fiber intake among participants (n = 813) was 15.72 g/day. Overweight individuals consumed significantly less total fiber (13.18 ± 0.44 g/day) compared with those of normal weight (16.09 ± 0.22 g/day). Normal-weight participants obtained fiber mainly from fruits, vegetables, and legumes, while the overweight group relied more on potatoes and white bread. Fiber intake was also negatively correlated with BMI (p < 0.001). Conclusions: Low fiber intake is widespread among young adults and associated with higher BMI. The findings suggest that not only the quantity but also the quality of fiber sources play a role in weight status. Interventions aimed at improving dietary fiber intake through targeted education and healthier food environments would be a good strategy to support better health outcomes in young adults. Full article

Background/Objectives: Maintaining independent mobility among older adults requires complex cognitive and physical health and is influenced by various health-related factors. This study sought to examine the relationship between health-related factors and driving among community-dwelling older adults by comparing the health status of currently driving individuals and those who have ceased driving. Methods: A secondary data analysis was conducted using the 2023 Korean Elderly Survey, collected between 4 September and 12 November 2023. A total of 4114 individuals aged 65 years or older were included. Statistical analyses were performed using chi-square tests, independent t-tests, and weighted binary logistic regressions via IBM SPSS for Windows. Results: Significant health-related factors for driving cessation included having ≥2 chronic diseases (OR = 1.22, p = 0.041), diagnosed depression (OR = 3.64, p = 0.030), Instrumental Activities of Daily Living dependency (OR = 1.67, p = 0.001), visual discomfort (OR = 1.18, p = 0.048), depression risk (OR = 1.34, p = 0.015), suspected cognitive impairment (OR = 1.73, p < 0.001), and poor self-rated health (OR = 1.21, p = 0.029). None of the participants with Parkinson’s were currently driving, whereas polypharmacy (≥5 medications) was not statistically significant (OR = 0.77, p = 0.222). Chronic diseases that may affect driving were also not statistically significant. Conclusions: This study highlights the fact that older drivers may have difficulty recognizing health-related risks that affect driving. To support safe mobility, it is essential to implement a health-centered assessment of driving fitness, including an appropriate evaluation cycle, and promote continuous education to raise awareness among older adults. Full article

The World Health Organization and the Centers for Disease Control and Prevention recommend seasonal influenza vaccination for all individuals aged 6 months and older. Despite high national immunization rates, the influenza vaccination coverage among Saudi children remains unclear. Parental knowledge and attitudes significantly impact children’s vaccination rates. Purpose: This study aims to evaluate parental knowledge, awareness, and attitudes regarding influenza vaccination and identify barriers to vaccination uptake among children in Al-Madinah City, Saudi Arabia. Methods: The population includes parents having children aged 6 months to 14 years. A cross-sectional survey utilizing a 33-item validated questionnaire was conducted to evaluate parental awareness, knowledge, and attitudes toward the influenza vaccine. Inferential statistics were employed to evaluate demographic factors influencing parental knowledge and attitudes toward vaccination. Results: This study surveyed 407 parents from Al-Madinah, focusing on their awareness, knowledge, and attitudes towards seasonal influenza vaccination. The sample was primarily Saudi (86.7%), with a mean age of 34 years. Most parents (95.6%) were aware of the vaccine, primarily through media and campaigns. Despite this, only 44.5% had vaccinated themselves or their children, citing perceptions of influenza as mild, vaccine ineffectiveness, and availability issues as primary reasons for non-vaccination. Knowledge about influenza varied, with most parents aware of its contagiousness (64.4%) and symptoms, but misconceptions persisted, such as believing the vaccine could cause the flu. Parental attitudes towards vaccination were mostly positive, with high trust in health information sources and a mean attitude score of 22.48 out of 35. Positive attitudes were correlated with better knowledge and more frequent infection control practices. Age, education, and medical profession status significantly influenced knowledge, while vaccine attitudes were most favorable among those vaccinated (p < 0.001). Conclusions: Most parents in Al-Madinah recognize the importance of vaccination; however, misconceptions about vaccine safety, perceived low need, and barriers such as vaccine availability persist. Sociodemographic factors, including education, income, and profession, are linked to better knowledge and more positive attitudes toward vaccination. Full article

Background: Maternal mortality remains a significant public health challenge in Brazil, reflecting persistent social, racial, and regional inequalities. Objectives: This study aimed to analyze trends and characteristics of maternal deaths in Brazil from 2000 to 2020, identifying sociodemographic and clinical risk factors. Methods: A retrospective, population-based study was conducted using secondary data from the Sistema de Informações sobre Mortalidade (SIM) of the Brazilian Ministry of Health. Descriptive and comparative statistical analyses were performed, including chi-square (χ²) goodness-of-fit tests and 95% confidence intervals calculated by the Wilson method. Variables were stratified by region, age, race, education, type and period of death, and investigation status. Results: A total of 40,907 maternal deaths were recorded. From 2000 to 2020, Brazil recorded 40,907 maternal deaths. The maternal mortality ratio decreased from approximately 74 deaths per 100,000 live births in 2000 to 57 per 100,000 in 2020, representing a 23% reduction over two decades. Most deaths occurred among young, Brown women with low education levels, particularly in the Southeast and Northeast regions. Direct obstetric causes accounted for two-thirds of cases, and most deaths occurred in hospital settings, mainly during the early puerperium. Conclusions: Despite progress, maternal mortality in Brazil remains above the WHO target and is strongly influenced by social inequities. Strengthening primary care, improving referral networks, expanding postpartum follow-up, and enhancing surveillance systems are essential for preventing avoidable deaths and achieving reproductive justice. Full article

In the US, research suggests that racial disparities exist in the prevalence of postpartum depression (PPD) and postnatal anxiety (PNA), with Black mothers experiencing PPD and PNA at a higher rate than their white counterparts. As a result, research that attempts to understand the antecedents of PPD and PNA in Black mothers may have value to the development of better interventions to reduce both in this subpopulation. Theory suggests that race-related stress (RRS) may be a contributing factor to PPD and PNA symptoms among Black mothers. RRS is defined as the stress associated with racism and discrimination encountered by Black women in their daily lives. In the current study, to test the relationship of RRS to PPD and PNA, we surveyed (N = 79) Black mothers who recently gave birth. The survey consisted of the Index of Race-Related Stress (IRRS), the Edinburgh Postnatal Depression Scale (EPDS), and the Postpartum Specific Anxiety Scale (PSAS-RSF), along with items capturing income, education, mental health status, and the number of children per mother. Income and mental health status, education, and the number of children per mother were used as covariates in a multivariate regression model with IRRS scores as the independent variable and EPDS and PSAS-RSF scores as twin dependent variables. These covariates were selected because of their established relationship with PPD and PNA. The data was analyzed using structural equation modeling. The results indicated that the model provided good fit to the data, (X² = 6.32, df = 9; p = 0.707; RMSEA = 0.00 [90% CI: 0.000, 0.097]; CFI: 1.0). Moreover, IRRS scores were significantly correlated with both PPD symptoms (β = 0.45; p < 0.001) and PNA symptoms (β = 0.3837, p < 0.001), respectively. Such results suggest that future research into the role race-related stress plays in the development of PPD symptoms and PNA symptoms may have value in the reduction in both among Black mothers. Full article

Background: Parents’ dietary strategies shape children’s eating habits. This study investigated socio-demographic determinants of maternal feeding practices among school-aged children in the Pomeranian province of Poland. Using a cross-sectional survey conducted in July 2025, we compared feeding strategies based on family structure, maternal employment, and number of children, and identified distinct parenting profiles through cluster analysis. Methods: A cross-sectional survey was conducted in July 2025 among 719 mothers of elementary school children in Pomeranian Voivodeship, using a convenience sampling design. An abbreviated version of the Comprehensive Feeding Practices Questionnaire (CFPQ) with 16 items across eight subscales was used. ANOVA compared feeding strategies between groups, Spearman correlations examined associations, and k-means cluster analysis identified maternal parenting profiles. Results: Encouragement and modeling were the most frequent strategies, while monitoring was least common. Mothers raising children with a partner and those employed used monitoring, modeling, and encouragement more often. Single or non-working mothers relied more on food as a reward and for emotion regulation. Mothers of only children applied control and monitoring less intensively than mothers with multiple children. All strategies were positively correlated. Cluster analysis identified three parenting profiles: intensely directive, moderate, and emotional-supportive. Conclusions: Maternal feeding strategies vary with socio-demographic factors. Educational interventions promoting healthy eating should be tailored to family structure and mothers’ employment status. Full article