Search Results (306)

Background: Mental health problems often begin in adolescence, yet early detection and intervention remain limited. This study assesses the prevalence of psychological distress and its correlates among high-school students in Makkah, Saudi Arabia, and explores whether specific symptom clusters of depression, anxiety and bipolar/mania can be identified using the General Health Questionnaire-30 (GHQ-30). Methods: A cross-sectional survey was conducted during the 2025–2026 academic year using stratified cluster sampling. A total of 535 students aged 15–18 years completed a questionnaire containing the validated Arabic GHQ-30 and demographic, socioeconomic and lifestyle items. The GHQ-30 was scored with binary 0-0-1-1 scoring (cut-off ≥ 6) to define cases of psychological distress. Item clusters were used to screen for probable depression, anxiety and bipolar/mania. Descriptive statistics characterized the sample. Associations were examined using chi-square tests and multivariable logistic regression. Results: Overall, 70.5% of participants screened positive for psychological distress. The prevalences of probable depression, anxiety and bipolar/mania were 33.1%, 28.2% and 31.2%, respectively. In adjusted models, female gender, insufficient sleep, lack of physical activity and exposure to bullying were associated with increased odds of psychological distress; longer sleep was protective. History of mental health conditions was a strong predictor of probable depression, whereas medication use was protective. Older age and higher paternal education were protective for anxiety. Bullying was the most consistent predictor across all symptom clusters. Conclusions: Psychological distress is highly prevalent among Makkah high-school students. Key determinants include gender, sleep duration, lack of physical activity and bullying. Routine school-based mental health screening, sleep-hygiene education, anti-bullying initiatives and early referral pathways are warranted. Further research should examine and validate GHQ-30 item clusters for specific disorders. Full article

Water, sanitation, and hygiene (WASH) services are essential for learner health and equitable education. Persistent gaps in WASH infrastructure and hygiene provision remain a major challenge in low- and middle-income countries. We assessed WASH interventions, learner knowledge and perceptions, and implementation challenges and opportunities in five selected primary schools in eThekwini District, South Africa. We conducted a cross-sectional study among Grade 7 learners using a structured questionnaire adapted from the World Health Organization (WHO) Surveillance of WASH in Schools Tool, complemented by observational checklists. Stratified random sampling yielded 129 participants (76 girls and 53 boys), with a 72% response rate. Quantitative data were analysed using Chi-square, Fisher’s exact, and Kruskal–Wallis tests, as appropriate. Although drinking water access was generally reliable, significant gaps were observed in sanitation privacy, soap and toilet paper availability, cleanliness, and menstrual hygiene facilities. Female learners consistently reported poorer conditions than males (p < 0.05). The Hygiene Access Index differed significantly across gender and age groups (p < 0.05), reflecting inequitable provision of hygiene materials. Despite educational initiatives, substantial shortcomings persist in school WASH systems, particularly regarding sanitation privacy, hygiene supplies, and menstrual hygiene management, with potential implications for learner health, educational participation, gender equity, and school attendance. Sustaining gender-responsive WASH systems is essential for improving learner health and promoting equitable educational environments. Sustainable WASH systems refer to the consistent availability, functionality, maintenance, and equitable use of WASH infrastructure and services over time, supported by institutional capacity and behavioural adherence. These findings highlight the need for implementation-focused and systems-oriented approaches to strengthen sustainable WASH service delivery in resource-constrained school settings. Full article

Hand hygiene is a cornerstone of infection prevention, yet adherence often declines once public health emergencies subside. This study examines post-pandemic hand hygiene practices and knowledge among public health trainees. We conducted a cross-sectional study of graduate students (N = 93) at a U.S. School of Public Health between May and October 2025. Participants completed a self-administered questionnaire assessing knowledge, self-reported practices, and demographics, with associations analyzed using chi-square tests. Results indicated that while 65.6% of participants possessed good knowledge (mean score 6.92 ± 1.92), only 23.7% met the criteria for good hand hygiene practice. Knowledge level was not associated with practice (p = 0.631). In contrast, sex was strongly associated with behavior: 34.4% of females reported good practice compared with 3.1% of males (p = 0.0016). Furthermore, adherence in high-risk situations was low, with only 7% reporting handwashing after coughing or sneezing. In conclusion, hand hygiene knowledge did not translate into consistent preventive behavior among these trainees. The observed differences by sex suggest that post-pandemic interventions should prioritize behavioral and social determinants rather than relying on information-based strategies alone. Full article

Strongyloides stercoralis (S. stercoralis) is an important soil-transmitted helminth that infests over 600 million people worldwide. However, data on its seroprevalence in remote regions, such as Thailand’s island areas, remain limited. This study examined the seroprevalence and associated risk factors of anti-Strongyloides spp. IgG seropositivity among primary school children in Koh Yao, an island in southern Thailand. A total of 351 primary school children (156 males and 195 females) were included. The seroprevalence of anti-Strongyloides spp. IgG was determined using the Strongyloides-specific IgG antibodies ELISA, and risk factor data were collected through a questionnaire. Hematological parameters were also analyzed. Univariate and multivariate logistic regression analyses were used to assess associations between risk factors and anti-Strongyloides spp. IgG seropositivity. The seroprevalence of anti-Strongyloides spp. IgG was 3.7% (13/351 participants). Analysis of the risk factors revealed that participants who drank filtered water exhibited lower odds of anti-Strongyloides spp. IgG seropositivity compared to those who drank tap or rainwater (AOR = 0.21, 95% CI 0.05–0.95, p = 0.043). However, due to the small number of seropositive cases, this association is hypothesis-generating and likely serves as a proxy for better household hygiene rather than a direct protective factor. This study is the first report on anti-Strongyloides spp. IgG seropositivity among primary school children in Koh Yao, southern Thailand, demonstrating a low seropositivity rate in this population. These findings provide location-specific information on modifiable risk behaviors, aiding in developing more effective control and prevention strategies for anti-Strongyloides spp. IgG seropositivity in Thailand’s island area. Full article

Background: Dental caries remain a major public health issue among Italian children, with prevalence exceeding 60% in specific subgroups and marked socioeconomic gradients. Objectives: This multicenter study aimed to describe baseline caries experience, malocclusions, and oral hygiene status in pediatric populations residing in three Italian regions and to develop and preliminarily evaluate the feasibility of an integrated care pathway for the prevention and management of caries and malocclusions. Materials and Methods: Within the CCM 2024 program (ID 10), a cross-sectional baseline assessment was conducted on 795 children aged 6–11 years, examined in school settings and via mobile dental units. Caries experience was assessed using the dmft/DMFT indices and International Caries Detection and Assessment System (ICDAS) criteria. Malocclusions were evaluated using the Index of Orthodontic Treatment Need (IOTN). Oral hygiene was assessed through standardized clinical indices. The proposed care pathway comprises three tiers: (1) universal, school-based oral health education; (2) targeted clinical preventive and interceptive interventions; and (3) telemedicine/AI-supported follow-up for high-risk children. Descriptive and multivariable statistical analyses were performed. Results: At baseline, overall caries burden was low. No statistically significant differences in dmft/DMFT were observed between males and females. A non-significant trend toward higher caries indices was found among children with a positive breastfeeding history. By contrast, oral hygiene level was strongly associated with caries indices: children with insufficient hygiene had the highest dmft/DMFT, those with moderate hygiene showed intermediate values, and those with optimal hygiene presented the lowest caries experience. In multivariable models, oral hygiene emerged as the main independent predictor of dmft/DMFT. Conclusions: In this low-caries cohort, oral hygiene was confirmed as the principal modifiable determinant of caries risk. A tiered, school- and community-based care pathway focused on hygiene promotion, early screening, and minimally invasive clinical interventions appears feasible at baseline and may be scalable, with the aim of reducing the burden of caries and malocclusions and improving equity in pediatric oral health. Full article

Oral squamous cell carcinoma (OSCC), comprising ~90% of oral malignancies, remains a major global health burden with rising incidence despite declining tobacco use. While tobacco and alcohol are classic dominant risk factors, a distinct subgroup of nonsmoking, nondrinking (NSND) patients is increasingly recognized, accounting for 15–35% of OSCC cases in many cohorts, particularly in developed countries. This emerging epidemic shows striking demographic patterns: strong female predominance (often 65–77% of cases), bimodal age distribution with peaks in young adults (<45 years) and elderly individuals (>70 years), and overrepresentation among non-Hispanic White and certain Asian populations. Unlike traditional habit-related OSCC, which favors the floor of the mouth in older males, NSND tumors predominantly arise on the lateral tongue, gingiva, and buccal mucosa. Etiopathogenesis extends far beyond conventional carcinogens and involves multifactorial mechanisms, including chronic mechanical irritation from dental factors, oral microbiome dysbiosis enriched with periodontal pathogens (e.g., Fusobacterium nucleatum and Porphyromonas gingivalis), limited roles for viruses (minimal HPV contribution, possible EBV or “hit-and-run” HSV effects), genetic susceptibilities (e.g., Fanconi anemia and CDKN2A mutations), epigenetic changes, hormonal influences contributing to female bias, metabolic conditions (diabetes and hyperlipidemia), poor oral hygiene, and chronic inflammation. NSND OSCC frequently exhibits a distinct immunological profile with higher tumor-infiltrating lymphocytes and PD-L1 expression, potentially favoring immunotherapy, though prognosis remains heterogeneous—better in some cohorts due to fewer comorbidities, yet worse in young patients with higher recurrence and second primary tumor risks. Delayed diagnosis is common due to low suspicion in “low-risk” individuals. This review underscores NSND OSCC as a unique entity requiring expanded risk assessment, heightened clinical vigilance for persistent oral lesions regardless of habit history, and targeted research into novel prevention and therapeutic strategies. Full article

Background: Population ageing has increased the number of older adults living in nursing homes, where loneliness and sleep disturbances are prevalent and negatively affect well-being. Evidence suggests a bidirectional relationship between loneliness and sleep quality, although research in institutionalised populations remains limited. Objectives: This study aimed to characterise the sociodemographic and health profile of nursing home residents in Northern Portugal and examine associations between sleep quality, loneliness, sociodemographic and health variables. Methods: A cross-sectional study was conducted with 157 older adults (≥65 years) across 13 nursing homes. Data were collected using a sociodemographic questionnaire and the Portuguese version of UCLA Loneliness Scale, Pittsburgh Sleep Quality Index and Montreal Cognitive Assessment. Pearson correlations and hierarchical multiple regression analyses were performed. Results: Participants were predominantly female (72.6%), widowed (55.4%), and aged ≥80 years. Most reported chronic conditions (98.7%) and limitations in activities of daily living (75.2%). Age showed modest positive correlations with loneliness. Loneliness dimensions were strongly associated with poorer sleep quality and greater daytime dysfunction. Hierarchical regression revealed that sociodemographic variables explained only a small proportion of variance in sleep quality. The addition of loneliness variables increased explained variance to 38.1%, highlighting loneliness as a key psychosocial predictor. Conclusions: Loneliness significantly influences sleep quality among older adults living in nursing homes. Interventions should integrate strategies to enhance social engagement alongside sleep hygiene measures. Longitudinal studies are recommended to clarify causal pathways. Full article

Background/Objectives: Acanthamoeba keratitis (AK) is a rare but sight-threatening corneal infection. This study reviews the clinical profile, diagnostic pathways, treatment strategies, and outcomes of AK cases managed over a 34-year period. Methods: We conducted a retrospective analysis of 52 microbiologically AK cases from 1983 to 2017. Results: The mean age at presentation was 27.7 ± 9.4 years, with a female predominance (63.5%). The majority (82.7%) were contact lens users, almost exclusively soft lens wearers, with documented risk behaviors such as poor hygiene and sleeping with lenses. 44.2% were initially misdiagnosed as nonspecific microbial keratitis. Common clinical findings included epithelial defects (30.8%), ring infiltrates (44.2%), superficial infiltrates (53.8%), hypopyon (30.8%), and corneal thinning (13.5%). Diagnosis was confirmed by culture/stain in 61.5% of cases, while others required confocal microscopy or corneal biopsy. Co-infections with bacteria were noted in ~20%. Prior to referral, 82.7% of patients had received empirical topical therapy. At KKESH, all received dual anti-Acanthamoeba therapy, and 69.2% underwent surgical intervention, including tectonic PKP (46.2%) and optical PKP (19.2%). Visual acuity improved from a mean logMAR of 1.51 at presentation to 0.87 at last follow-up. Anti-Acanthamoeba therapy was discontinued in 95.9% of patients by the end of follow-up, with steroid use tapering from 61.5% at 3 months to 16.3% at final visit. Conclusions: Acanthamoeba keratitis in Saudi Arabia predominantly affects young female contact lens users and often presents with diagnostic delays and misclassification as herpetic or bacterial keratitis. Despite aggressive medical and surgical therapy, visual outcomes remain suboptimal in many cases. Full article

Purpose: Traditional plaster and fiberglass casts remain widely used for fracture immobilization but are associated with recognized challenges, including skin irritation, hygiene limitations, and distress during cast removal, particularly in pediatric populations. Light-cured polymer immobilization (LCPI) systems have been introduced as an alternative method of fracture support. The primary objective of this study was to describe radiographic healing and alignment outcomes among patients treated with an LCPI system. Secondary objectives were to document skin- and device-related events and to identify any unplanned removals or subsequent re-interventions. Methods: A 6-month retrospective cohort study was conducted involving 108 consecutive patients treated with an LCPI system between January and June 2025 at a single orthopaedic clinic. Clinical and radiographic records were reviewed to extract demographic information, injury characteristics, treatment details, immobilization duration, healing outcomes, alignment status, and recorded adverse events. Outcomes were summarized using descriptive statistics. Results: Immobilization was applied for 104 fractures (96.3%), three sprains (2.8%), and one elbow dislocation (0.9%). The cohort (76 males, 32 females; mean age: 13.4 years; range: 4–53) demonstrated radiographic union or progression toward union among fracture cases with available follow-up imaging. Mean immobilization duration was 29.2 days (SD: 6.2; range: 10–48). Alignment at device removal was documented as anatomic or near-anatomic in 103 of 104 fractures (99.1%) based on treating clinician assessment (99.1%). Device breakage was documented in 12 cases (11.1%), of which 3 required additional immobilization. Two patients (1.9%) experienced mild cutaneous reactions that resolved with conservative management. No severe device-related complications were documented. Conclusions: Healing outcomes and recorded adverse events were consistent with expected clinical patterns for this patient population in this descriptive retrospective cohort of patients treated with an LCPI system. These findings provide descriptive real-world data regarding clinical utilization and short-term outcomes in selected patients. Prospective comparative studies are needed to further define effectiveness, safety, cost considerations, and broader applicability across diverse fracture populations. Full article

Background/Aim: This study aims to assess the prevalence of self-reported oral ulcers and their associated factors among patients with type 2 diabetes mellitus (T2DM) in Bangladesh. Materials and Methods: A hospital-based cross-sectional study was conducted among 260 patients with T2DM attending outpatient dental services at three tertiary hospitals in Dhaka. Data were collected using a semi-structured questionnaire covering sociodemographic characteristics, behavioral and dietary factors, medical history, and self-reported oral mucosal conditions. Associations between oral ulcers and potential risk factors were analyzed using Chi-square and Fisher’s exact tests. Results: Most participants were middle-aged (50–59 years), female, of low educational status and married, with a high prevalence of regular tooth-brushing but low use of oral hygiene aids such as mouthwash. Traumatic ulcers (21.5%) and oral lichen planus (19.6%) were the most frequently observed oral mucosal lesions followed by recurrent aphthous ulcers, oral lichenoid reactions, and oral candidiasis. Traumatic ulcers and oral lichenoid reactions showed associations with sharp teeth, dentures or braces, and amalgam restorations, while lichen planus and aphthous ulcers were significantly associated with smoking, systemic conditions such as hypertension, and coexisting oral lesions such as oral candidiasis. Multivariable logistic regression showed that sharp teeth, denture or brace use, amalgam restorations, and tobacco-related habits were associated with oral lesions. Conclusions: Oral ulcers and related mucosal lesions were found to be common among patients with T2DM in Bangladesh, with traumatic ulcers being most frequent and several local and behavioral factors showing significant associations. Full article

Background: Sleep hygiene protocols (SHPs) have been shown to improve sleep and stress regulation; however, the role of cortisol in shaping downstream physiological and performance adaptations remains unclear. This study primarily examined the effects of a short-term SHP on sleep duration and salivary cortisol responses across resting, pre-exercise, and post-exercise states in female collegiate soccer players and, secondarily, whether cortisol statistically mediated selected aerobic and anaerobic performance outcomes. Methods: Fourteen players (22.1 ± 3.3 y; 157.8 ± 6.0 cm; 53.5 ± 3.9 kg) completed a randomised, counterbalanced crossover study comparing habitual sleep (no sleep hygiene protocol; nSHP) with a comprehensive SHP incorporating environmental, behavioural, and educational strategies. Salivary cortisol was sampled one hour post-waking and 30 min pre- and 15 min post-exercise during standardised testing sessions. Performance outcomes included vertical jump, sprint performance (40 m and repeated sprints [RAST]), and the Yo-Yo Intermittent Recovery Test Level 1. Linear mixed-effects models assessed cortisol responses, and mediation analyses explored cortisol–performance relationships. Results: After SHP, perceived (7.87 h vs. 6.5 h; p = 0.002, ESg = 1.0) and calculated sleep duration (8.5 h vs. 6.9 h; p = 0.004, ESg = 0.95) increased significantly. Cortisol was markedly lower following SHP at selected timepoints, including before RAST (−43.05%, p = 0.006, ESg = 0.84), with additional timepoint-specific, condition-dependent differences post-anaerobic and post-aerobic exercise (Δ = 7.37 and 5.98 nmol·L⁻¹, respectively; p < 0.001). Vertical jump height demonstrated significant total (9.92 cm, p = 0.002) and direct effects (7.72 cm, p = 0.034), and peak repeated-sprint performance showed a significant direct effect (p = 0.026). Cortisol did not significantly mediate any performance outcomes (ACME p > 0.05). Conclusions: Short-term sleep hygiene is associated with increased sleep duration, timepoint-specific modulation of cortisol responses, and selected anaerobic performance benefits; however, these effects were not explained by measured cortisol responses and are unlikely to be sustained without ongoing reinforcement or support, particularly in athletic populations. Full article

Background and Objectives: Sleep is a vital psychological function for health and well-being in all age groups, from children to adolescents, to adults and the elderly, and impacts quality of life. This study evaluated temporal changes in sleep quality and lifestyle behaviors among medical students in North-Western Romania (Transylvania) between the COVID-19 pandemic and the post-pandemic period. Materials and Methods: A cross-sectional design was employed involving 709 medical students assessed during the first pandemic wave (2020) and the 2023–2024 academic year. Online questionnaires collected data on demographics, body mass index (BMI), substance use, and physical activity. Sleep quality was measured using the validated Athens Insomnia Scale (AIS), and multiple linear regression was performed to identify predictors of sleep outcomes. Results: Post-pandemic data revealed a significant decline in sleep quality, with female gender and lower academic performance identified as significant predictors of insomnia symptoms (R² of 0.258, p < 0.05). While physical activity levels improved significantly in 2024 compared to the confinement period, this was accompanied by increased fast-food consumption and a rise in overweight and obesity rates. Conversely, illicit drug use decreased, and alcohol consumption patterns shifted, characterized by reduced weekly frequency among females but persistent binge drinking episodes. Conclusions: The transition to post-pandemic education yielded mixed health outcomes; while physical activity rebounded, sleep quality and nutritional status deteriorated. These findings highlight the necessity for university-based interventions focusing on sleep hygiene, nutrition, and stress management to support the well-being of medical students. Full article

Background: Soil-transmitted helminth (STH) infections are a recognized public health challenge, particularly in rural and island settings. Despite the implementation of national control programs, epidemiological data from geographically isolated communities remain limited. In this study, we aimed to determine the prevalence of STH infections and identify associated risk factors among adults in Koh Yao Islands, southern Thailand. Methods: A community-based cross-sectional survey was conducted in three subdistricts of Koh Yao, Phang Nga Province, from January to September 2024. Demographic data and information on potential risk factors were collected using structured questionnaires. Stool specimens were analyzed using the formalin–ethyl acetate concentration technique and the modified Kato–Katz method. Associations were assessed using univariate and multivariate logistic regression analyses. Results: A total of 241 adults participated in the study, with females accounting for 68.9% and males for 31.1%. The overall prevalence of STH infections was 2.49%, with hookworms and Trichuris trichiura identified as the predominant species. All infected individuals had an educational level lower than a bachelor’s degree. Univariate analysis showed that participants who did not use hygienic toilets at home had a significantly higher likelihood of developing STH than those who did (crude odds ratio = 46.80; 95% confidence interval [CI]: 2.55–859.00; p = 0.010). Multivariable logistic regression analysis confirmed that the absence of hygienic toilet use at home was independently associated with STH infection (adjusted odds ratio = 30.69; 95% CI: 1.17–804.65; p = 0.040). Conclusions: This study documents low overall prevalence of STH infections in the study area, with hookworms and T. trichiura as the predominant organisms. These findings support continued targeted public health measures, including periodic deworming and health education initiatives, to strengthen hygiene practices, particularly in high-risk populations. Future investigations should incorporate environmental assessments and longitudinal monitoring to evaluate the durability of current control strategies. Full article

This five-month epidemiological investigation evaluated pre-slaughter welfare, carcass-processing practices, and post-mortem lesion prevalence in 1012 cattle and 413 pigs slaughtered in Enugu State, Nigeria. Direct observations and post-mortem inspections were conducted following OIE standards. Animal welfare was markedly compromised. Cattle were dragged from the lairage to kill floor, restrained in lateral recumbency for over 30 min before bleeding, and slaughtered without stunning. Pigs were transported tied to motorcycles and processed on unsanitary floors. The lairages lacked roofing, clean water, and adequate drainage. Carcass handling was unhygienic, with meat processed near maggot-infested drains and transported in open vans or motorized tricycles used to commute passengers and cement. Of all cattle examined, 45.3% (458/1012) exhibited gross lesions attributable to contagious bovine pleuropneumonia (CBPP, 15.5%), fasciolosis (18%), liver abscessation (6.6%), ascariasis (4.6%), and bovine tuberculosis (0.5%). No lesions were detected in pigs. Lesion occurrence differed significantly (p < 0.05) by sex (males = 44.1%, females = 66.7%), age (<4 years = 54.1%, ≥4 years = 45.4%), breed (White Fulani = 45.5%, others = 36.7%), slaughterhouse location, and season (rainy = 45.2%, dry = 45.5%). Temporal analysis showed the highest lesion rate in April (68.3%), declining to 37.7% in May. Lesions of CBPP and fasciolosis were significantly more frequent in young cattle and during the rainy months (p < 0.05). These findings reveal systemic welfare violations and disease endemicity within the municipal abattoirs surveyed. The combination of poor pre-slaughter welfare, unhygienic meat handling, and high prevalence of zoonotic and economically important livestock disease lesions highlights urgent public health concerns. Strengthening abattoir infrastructure, enforcing pre-slaughter animal welfare and hygiene regulations, mechanizing slaughter processes, and instituting continuous surveillance within the One Health framework are essential for ensuring meat safety and public health security in Nigeria and beyond. Full article

Objectives: Endodontic complications are among the most frequently reported biological complications in tooth-supported fixed dental prostheses (FDPs). The aim of this study was to evaluate the prevalence of periapical complications in FDPs placed on vital and non-vital abutments and to identify risk factors for these lesions. Methods: This retrospective clinical trial was conducted on participants who had attended routine follow-up visits at the dental hospital at Qassim University, Saudi Arabia. Participants were examined clinically and radiographically for the presence of periapical lesions. Information was recorded on the design, material, location of the prostheses, and oral hygiene. The survival and lesion-free survival rates were determined using the Kaplan–Meier method. Life-table analysis was performed to assess the mean time to event. Univariate Cox proportional hazards regression analysis was used to assess potential risk factors for the development of periapical lesions (α = 0.05). Results: A total of 495 FDPs were placed in 302 participants, with a mean age of 45.7 ± 13.4 years and a mean follow-up period of 7.5 ± 6.5 years. Lesions were detected in 32.3% of FDPs during follow-up. There were no significant differences in the prevalence of lesions in vital compared with non-vital abutments or between males and females (p > 0.05). Poor oral hygiene was the most significant risk factor for the development of periapical lesions (p < 0.05). Univariate Cox regression analysis showed that anterior–posterior FDPs had a higher risk of lesions (p = 0.035). No significant associations were found between lesions and the material used or the design of the abutment (p > 0.05). Conclusions: Periapical complications in FDPs are mainly influenced by oral hygiene and the location of the FDPs, whereas abutment vitality and material type appear to have limited impact. Full article