Search Results (1,647)

What happens to emotional life when running water fails not for a day but for a decade? Drawing on 20 semi-structured interviews in a rural Romanian commune that went more than ten years without a functioning public water supply, and where a new network now reaches only part of the settlement, we examine how the emotional demands of chronic water scarcity are socially organised. We identify four recurrent patterns, which we analyse as feeling rules: shame before visiting outsiders, worry tied to falling household reserves, hope maintained in public, and resignation expressed in contained, formulaic terms. The four carry unequal normative warrant, which we assess explicitly. We propose the concept of infrastructural emotion work, the unpaid emotion work generated by the sustained failure of systems socially expected to function, and identify formulaic emotional display as one of its mechanisms, in which a conventional phrase provides an interactionally acceptable response while foreclosing elaboration. We argue that these expectations are socio-materially generated rather than culturally prescribed alone, and that the resulting burdens are unevenly distributed by gender. Where infrastructure is unreliable, households assemble an emotional infrastructure of their own. Full article

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in substantial global morbidity and mortality since its emergence in late 2019. This retrospective study aims to determine the comorbidity patterns, co-occurrence networks, and associated demographic factors among 244 deceased COVID-19 cases in Grenada between 2021 and 2022. The prevalence of comorbid conditions varied considerably across diseases. Hypertension was the most frequently observed condition (41%) followed by diabetes (34.8%), and ARDS (27%). Our co-occurrence analysis revealed a densely interconnected core of cardiometabolic and respiratory conditions, particularly involving hypertension, diabetes, and ARDS. Stratified clustering analyses demonstrated that multimorbidity patterns were broadly consistent across gender but differed by age group and vaccination status, with older individuals showing more pronounced clustering of cardiometabolic conditions. Logistic regression analysis further identified age and gender as significant factors associated with the distribution of specific comorbidities, including higher odds of hypertension among older individuals. This study highlights the central role of cardiometabolic diseases and older age in COVID-19 mortality in Grenada in 2021–2022 and underscores the importance of multimorbidity structures rather than isolated conditions. We suggest early identification of high-risk multimorbidity profiles, particularly among older adults, to improve clinical management and preventive strategies during future infectious disease outbreaks. Full article

Background/Objectives: Empathy is a fundamental component of patient-centered care and plays a critical role in the physician–patient relationship. This study aimed to evaluate empathy levels among undergraduate medical students at a medical university in Romania, examined from a Medical Humanities perspective, and to analyze how these scores are distributed according to gender, academic year, clinical stage, and direct experience with patient contact. Methods: A descriptive, cross-sectional study was conducted among 209 undergraduate medical students across all six academic years. Empathy levels were assessed using the Romanian-language version of the Jefferson Scale of Empathy—Student Version (JSE-S). Differences in empathy scores were analyzed using independent samples t-tests and a one-way analysis of variance (ANOVA) with Tukey Honestly Significant Difference (HSD) post hoc comparisons. Statistical significance was set at an alpha level of less than 0.05. Results: Internal consistency of the JSE-S total scale was good (Cronbach’s α = 0.829). The overall mean total JSE-S score was 107.34 ± 14.34. Female students demonstrated significantly higher empathy scores compared to male students (109.92 ± 13.10 versus 99.37 ± 15.20; t = 4.450; p < 0.001; Cohen’s d = 0.77). No statistically significant differences were found between preclinical and clinical stage students (106.84 ± 14.75 versus 108.98 ± 12.90; p = 0.363; Cohen’s d = −0.15), between students with and without direct patient contact (108.20 ± 14.14 versus 104.48 ± 14.78; p = 0.115; Cohen’s d = 0.26), or across the six academic years (F = 1.614; p = 0.158; partial η² = 0.038). Conclusions: Medical students demonstrated moderate-to-high empathy levels, with gender representing the only statistically significant demographic factor. The absence of major differences across academic-year cohorts and clinical exposure suggests that empathy levels were comparably represented across the different stages of training within this cross-sectional sample. These findings contribute descriptive data on empathy levels among Romanian medical students and highlight gender as the main factor associated with variation in empathy scores in this sample. Full article

Background: Rural and resource-constrained settings face major barriers to timely cancer screening, diagnosis, and treatment due to limited specialist availability and centralised service-delivery models. In the Eastern Cape, a largely rural province with a constrained oncology workforce, a decentralised–centralised hybrid model was introduced to improve access to cancer care. Nelson Mandela Academic Hospital serves as the central referral hub within this model. This study evaluates the implementation process and impact of this decentralised cancer care model on service utilisation, access, and continuity of care. Methods: A quantitative quasi-experimental pre–post implementation and quality improvement evaluation was conducted using retrospectively collected routine service utilisation and programme data from April 2023 to February 2025. The study assessed the impact of a decentralised oncology care model on access, service integration, and utilisation outcomes. Data from facility registers and district health information systems were managed using Microsoft Excel and analysed using Stata and IBM SPSS Statistics. Descriptive statistics, correlation analysis, and linear regression were used to compare pre- and post-implementation changes in patient volumes, screening coverage, referral completion, workforce capacity, gender distribution, and service uptake. The intervention decentralised screening, diagnosis, follow-up, and patient navigation services to district and satellite facilities while centralising specialised oncology care at referral centres to improve accessibility, efficiency, and continuity of care. Results: Cancer patient attendance increased substantially over the study period, from 355 patients in April 2023 to a peak of 1039 in April 2024, with a sustained upward trend (B = 18.03, p = 0.005), reflecting an average monthly increase of 18 patients. Female patients accounted for most visits, while male attendance showed a significant increasing trend (B = 8.03, p < 0.001). Service integration improved, with strong positive correlations between new patient registrations, follow-up care, palliative services, and inpatient admissions, indicating an expanding continuum of care. Breast and cervical cancers contributed the highest service burden, while cervical and lung cancers showed significant upward trends. Seasonal variation in attendance was observed, particularly during festive periods. From an implementation perspective, screening coverage for priority cancers increased by 18%, while 732,349 individuals were reached through community awareness initiatives. Access improved substantially, evidenced by a reduction of 56,400 km in cumulative patient travel distance over one year. Workforce capacity was strengthened through the training of 517 healthcare workers, and 1943 patients received structured navigation support. Referral efficiency and continuity of care improved, although persistent bottlenecks were observed in diagnostic and referral pathways. Conclusions: The decentralised–centralised oncology care model demonstrated improved cancer service utilisation, access, and continuity of care in a rural, resource-limited setting. However, increasing patient volumes and interconnected service demands place additional pressure on health system capacity. Sustained investment in workforce development, screening—particularly for cervical cancer—and system efficiency is required. This model provides a scalable and context-appropriate framework for strengthening oncology services in similar low-resource settings. Full article

Objective: This study aimed to analyze the incidence and multifactorial causes of dislocation following primary total hip arthroplasty (THA) and to evaluate current surgical strategies for the prevention and management of this complication. Methods: This retrospective study included 1066 hips (median age 57 years; 805 females and 261 males) that underwent primary THA performed by a single surgeon between 1996 and 2025. The median follow-up duration of the patients was 46 months (min: 6, max: 357 months), and 68.9% had primary coxarthrosis, while 31.1% had secondary coxarthrosis. In this study, the effects of dislocation causes, age, gender, femoral head size, liner angle, posterior capsular repair, type of anesthesia, fixation method of the prosthesis, etiology, and surgical experience (distribution by years) on dislocation were statistically analyzed. Results: The analysis revealed that 44 of the 1066 hips (4.1%) developed a dislocation. The most common causes of dislocation were identified as femoral offset error (40.91%) and acetabular component malposition (31.82%). A statistically significant correlation was found between dislocation development and gender (p < 0.001) and femoral head diameter (p = 0.006); the dislocation rate was higher in male patients (8.0%) than in female patients (2.9%). A marked reduction in dislocation rates (1.6%) was observed following the routine use of large-diameter femoral heads (32–36 mm). The highest dislocation rate was observed during the early years of surgical experience (1996–2000, 6.8%). No statistically significant differences were found between dislocation development and age (p = 0.055), type of anesthesia, type of prosthesis, liner angle, and secondary etiological factors (p > 0.05). Conclusions: Instability developing after primary THA is a multifactorial complication. In our study, inadequate femoral offset restoration and acetabular component malposition were identified as the most common mechanical causes of dislocation. Male gender was significantly associated with an increased risk of dislocation, whereas the use of larger femoral head diameters was associated with lower dislocation rates. Our findings suggest that meticulous preoperative planning, accurate component positioning, increased surgical expertise, and the use of larger femoral head diameters may play important roles in reducing the risk of instability. Full article

Background: Antibiotic-associated diarrhea (AAD) is a common consequence of gut microbiota disruption following broad-spectrum antibiotic use. Certain probiotics may reduce the incidence of AAD. However, their effectiveness also depends on appropriate counseling by community pharmacy professionals and implementation of evidence-based practice. Objectives: To assess the knowledge, attitudes, and practices (KAP) of community pharmacy professionals in North Macedonia regarding concomitant antibiotic–probiotic use and to identify factors associated with these domains. Methods: An anonymous content-validated online questionnaire was distributed to a convenience sample of community pharmacists and pharmacy technicians in North Macedonia (April–May 2026). Data were analyzed using descriptive statistics, chi-square tests, factor analysis, and regression models in Jamovi (version 2.6) and R software (version 4.4). A p-value <0.05 was considered statistically significant. Results: Among 285 respondents (mean age 41.8 ± 9.6 years), 54.7% were classified in the high category of the survey-based knowledge index according to the prespecified survey key. Recognition of probiotic efficacy was high (95.8%), but alignment with the prespecified survey key regarding proper administration with food and risk identification was lower (34.6% and 66.8%, respectively). Attitudes toward probiotic use were highly positive, and recommendation practices were frequently reported (84.5%), although counseling practices varied. More positive attitudes were associated with higher recommendation behavior (β = 0.512, p < 0.001) and female gender was also associated with higher scores (p = 0.008). Recent continuous professional education was associated with higher counseling-related practice scores (p < 0.001), while greater variability in counseling behavior was observed across community pharmacy professionals. Conclusions: Community pharmacy professionals in North Macedonia demonstrated favorable attitudes and frequent self-reported recommendation practices regarding probiotic use alongside antibiotics. However, important gaps remain in clinical knowledge and counseling consistency. Targeted continuing professional education and development of standardized national guidelines may be considered, but their effects on observed practice and patient outcomes require prospective evaluation. Full article

Basketball involves high-intensity biomechanical loads that induce specific postural adaptations. In order to identify injury risk factors, establishing normative values for static knee alignment is crucial, yet radiographic screening in healthy populations is ethically limited. This observational study aimed to define the reference values for static knee alignment in a large cohort of amateur basketball players using the Knee Rotation Measurer (KRM^®) and to investigate the non-linear nature of morpho-functional adaptations. A cross-sectional study was conducted on 1150 amateur basketball players (590 males, 560 females; age 18–45 years), recruited from Italian leagues targeting a balanced geographical distribution. Static alignment was assessed using the KRM^® in a closed bipodal stance. Results revealed a universal tendency toward internal knee rotation (~20°), which was statistically independent of foot posture (p > 0.05). Significant sexual dimorphism was found in alignment variance: while mean right and left knee valgus values were similar in both sexes (p = 0.79), males exhibited significantly higher variance compared to female (12.53 vs. 9.36 cm²) and a dominant tendency toward knee varus (p < 0.001). In conclusion, amateur basketball players present a distinct morpho-functional profile characterized by a universal tendency toward internal knee rotation, which is statistically independent of foot posture. Furthermore, significant sexual dimorphism in morphological variance and sagittal alignment highlights distinct gender-specific postural adaptations in this population. Full article

Background/Objectives: This study aims to evaluate the pulp space morphology (PSM) of both first and second mandibular premolars in a sample of a Greek population using cone beam computed tomography (CBCT). Methods: Two hundred and ninety nine CBCTs of a Greek population were assessed to evaluate the PSM using Vertucci’s classification. CBCTs were prescribed for non-endodontic reasons. Results: In the aforementioned data set, the most common PSM was Vertucci’s 1 (V1) in all subgroups of mandibular premolars. V3 was the second most frequent PMS in the #34 group (10.67%), and it was V5 in the #35 group (3.1%), V3 in the #44 group (14%), and V8 in the #45 group (2.7%), with the rest of the morphologies being sparse. Across the four teeth, there was a statistically significant difference in Vertucci class distribution (p = 0.001). No significant difference was found between genders (p = 0.120); bilateral symmetry analysis showed high concordance for both premolars. Conclusions: Within the limitations of this study, it is concluded that the reported pulp space morphology in the mandibular premolars of a Greek sub-population sample presented as less complicated compared to other similar reports of (sub)-populations of different descent. Full article

This article addresses the underrepresentation of religion in historical accounts of apartheid’s gendered political economy. It asks how colonial missionary discourse and apartheid law interacted in constructing and regulating Black womanhood, and how intersectionality and Bosadi hermeneutics can expose and contest the theological legitimation of Black women’s labour, sacrifice, and endurance. The study uses a qualitative historical-theological and contextual biblical method. It analyses selected historical scholarship, South African legislation, the Constitutional Court’s Mahlangu judgment, and Proverbs 31:10–31 and Ruth, through the lens of Kimberlé Crenshaw’s intersectionality and Madipoane Masenya’s Bosadi hermeneutics. The analysis finds that mission Christianity and the apartheid state were neither identical nor uniform, but influential Christian ideals of domesticity, respectability, service, and feminine sacrifice could converge with a racialised system that restricted African women’s land, mobility, residence, labour, and family life. Proverbs 31 and Ruth are therefore treated as contested resources: they can affirm women’s agency and economic intelligence, but they can also be appropriated to moralise overwork and precarious survival. The article contributes an integrated historical-theological account that links law, labour, religion, and biblical reception without reducing African women to passive victims. It recommends that churches and theological institutions audit the distribution of labour and authority, support decent work and shared care, and interpret biblical texts with women whose lives are shaped by racialised and gendered inequality. Full article

Maternal guilt has become an increasingly prominent topic in sociological research on motherhood and work, particularly in the context of the expansion of dual-earner families, changing labor markets, and persistent gendered expectations surrounding care and family responsibilities. This study examines how self-employed mothers experience and negotiate maternal guilt and how these experiences contribute to the reproduction and renegotiation of norms of “good motherhood.” The study is based on twenty-four interviews with self-employed mothers in Croatia. The findings demonstrate that maternal guilt emerges at the intersection of intensive motherhood ideals, neoliberal expectations of productivity and availability, and the unequal distribution of household and emotional labor. Guilt is particularly pronounced in everyday situations involving perceived absence from one’s children and feelings of inadequacy in fulfilling maternal responsibilities. Although self-employment is often represented as a form of work that enables greater work–family balance through flexibility and autonomy, the findings show that it does not necessarily reduce time pressure or emotional burden. Instead, flexibility is often achieved through extended working hours, blurred boundaries between work and family life, and expectations of continuous availability. Mothers respond to these tensions through strategies of time reorganization, reliance on informal support networks, and the redefinition of “good motherhood” through a narrative of quality time and meaningful presence. The study concludes that self-employment increases mothers’ control over the organization of work but does not substantially transform the emotional dynamics of motherhood or the gendered distribution of care. Rather, it shifts the responsibility for managing work–family tensions onto individual mothers, thereby reproducing broader gendered expectations surrounding maternal responsibility. Full article

Background: Motor and intellectual disabilities (MIDs) belong to a restricted and vulnerable social group with health restrictions for maintaining and preserving adequate oral health. Silver nanoparticles (AgNPs) have appeared as an encouraging therapy due to their excellent antimicrobial effects; however, scientific information on the antimicrobial effectiveness of AgNPs against bacteria in patients with MIDs remains limited. This study aimed to evaluate the antimicrobial substantivity of AgNPs in oral bacteria from patients with and without MIDs. Methods: Fifty-four oral biofilm samples were obtained from 26 participants with MIDs and 28 participants without MIDs. The microbial inhibition activity and the antimicrobial substantivity of AgNPs were determined. The antibiofilm activity of the AgNPs was explored using scanning electron microscopy (SEM). Results: The AgNPs displayed uniform size distributions (9.8 ± 1.7 nm) and electrical charges in surface particles that limit particle clustering (−39.8 ± 3.3 mV). The AgNPs were more effective than chlorhexidine (CHX) in eliminating bacteria from oral biofilms derived from both MID and non-MID patients (p < 0.05); therefore, the antimicrobial substantivity of the AgNPs was statistically better than deionized water but lower than CHX at specific exposure times (p < 0.05). The antimicrobial effectiveness of AgNPs at even low concentrations was associated with the type of oral biofilm, the type of antimicrobial solution, and, in some cases, gender. SEM images indicate a clear alteration in oral biofilm structure when AgNPs were applied. Conclusions: AgNPs exhibited significant potential to limit oral bacterial proliferation from microbial biofilms while contributing to the maintenance of oral condition in individuals with MIDs. Full article

Coal phase-out regions concentrate the distributional risks of the energy transition, yet the tools used to identify energy-poor households in these territories still rely mainly on income and welfare criteria. This study asks whether such criteria can identify the households that suffer. Drawing on a survey of 706 households across six municipalities of Western Macedonia, Greece, the core territory of the national lignite phase-out, we validate a four-item Thermal Stress Index (polychoric ω = 0.885; loadings = 0.71–0.88; no differential item functioning by gender, income, or survey wave) and test nine hypotheses and one descriptive benchmark on prevalence, mechanisms, typologies, and targeting. Winter thermal inadequacy reaches 22.9%, which sits above the 19.0% national EU-SILC figure, reported as descriptive context. Dwelling energy features dominate all socioeconomic predictors of severe thermal stress (pseudo-R-squared 0.482 against 0.024), and no direct tenure association remains once envelope quality is included, while the protective association of income operates primarily through dwelling quality and is not observed across the range of inefficient dwellings. Latent class analysis identifies a hidden energy poverty class, 19.5% of households with severe experiential deprivation, above-average income, and no payment problems. A machine learning targeting audit shows that administrative criteria alone identify severely stressed households and show no discriminative capacity for identifying severely stressed households (AUC = 0.517), whereas adding dwelling and financial-strain information raises discrimination to an area under the curve of 0.938. Finally, in this sample, income-based screening is weakly associated with the households reporting severe thermal deprivation. Full article

Background/Objectives: Endo-periodontal lesions (EPLs) represent complex pathological entities involving both periodontal and pulpal tissues, often implying diagnostic and therapeutic challenges. Limited evidence exists regarding the relationship between periodontal disease staging and grading and EPL subtype. The aim is to evaluate the clinical and statistical distribution of endo-periodontal lesions and investigate their association with periodontal stage and grade according to the European Federation of Periodontology (EFP) classification. Methods: An observational retrospective study was conducted in the Department of Periodontology, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. Among 884 examined patients, 31 of them were diagnosed with EPLs and included in the analysis. Demographic variables, systemic conditions, affected tooth type, EFP stage and grade, and EPL type according to the Foce classification were recorded. Statistical analysis included Fisher’s exact test and univariable and multivariable binomial logistic regression models. Results: The mean age of the patients was 53.55 ± 9.42 years, with a nearly equal gender distribution. Most patients presented Stage III periodontitis (54.8%), Grade B periodontitis (71%), and EPL 3 (58.1%). Pluriradicular teeth were the most frequently affected (64.5%). The only statistically significant association identified was between EFP grading and EPL classification (p = 0.001). Grade B patients were significantly more likely to present EPL 3 than Grade C patients. Logistic regression analysis demonstrated that Grade B was a strong predictor of EPL 3 both in the univariable model (OR = 27.2; 95% CI: 2.712–272.828) and after adjustment for age and gender (OR = 32.676; 95% CI: 2.832–376.984). Neither age nor gender showed a significant association with EPL 3 occurrence. Conclusions: EPL 3 was the predominant lesion subtype in the study. EFP grading was significantly associated with EPL distribution, with Grade B emerging as an independent predictor of EPL 3. These findings suggest that periodontal disease progression may play a key role in the development and characterization of combined endo-periodontal lesions and highlight the importance of integrated periodontal–endodontic assessment in clinical practice. Full article

This study analyzes educational migration patterns in small towns across Dambovita County, Romania, focusing on spatial accessibility and gender disparities. Officially designated as Rank III urban settlements under national legislation, these small towns face structural regional imbalances. The research is based on a comprehensive structured questionnaire administered to a target sample of 143 graduates from 15 high schools across the surveyed municipalities. Given that the data collection depended on institutional access granted by school administrations, a non-probability purposive sampling approach was employed. The survey incorporated open-ended and closed-ended items capturing students’ institutional choices, secondary education profiles, intentions to pursue matching higher education fields, and underlying motivations. Survey data were integrated with spatial analysis methods using QGIS 3.34 version isochrones modeling and the OpenRouteService (ORS) Matrix to evaluate travel times and distances to competing regional university centers. The results reveal gender-based patterns differences in student mobility: female high school students concentrate on a single metropolitan destination, whereas male high school students are more broadly distributed secondary vocational nodes. Ultimately, this research contributes to understanding how gender intersects with educational migration and highlights the influence of transport infrastructure and spatial friction in students’ decision-making processes. Full article

This article analyzes the explicit and implicit presence of social justice in the graduation profiles of Social Work programs at Chilean state universities, as well as the way in which its distributive, recognition, and participatory dimensions are articulated within the declarative curriculum. An exploratory qualitative design was developed based on a comparative documentary analysis of twelve official graduation profiles, retrieved from institutional sources and analyzed through a matrix grounded in a plural conception of social justice. The results show that explicit references to social justice are exceptional and that, more frequently, it is expressed indirectly through references to human rights, public policies, diversity, human development, citizenship, or territory. The distributive dimension shows the greatest operational development, especially through public policies, program management, state action, social equality, and intervention in vulnerable contexts. The recognition dimension appears mainly at a declarative level, linked to diversity, pluralism, interculturality, and gender. The participatory dimension is the least operationalized, with limited references to deliberation, democratic governance, or shared decision-making. The study identifies three profile typologies: distributive-institutional; rights-, diversity-, and recognition-oriented; and relatively integrated profiles of plural social justice. The findings suggest that strengthening curricular coherence may require moving from general normative statements toward competencies, learning outcomes, and assessment criteria capable of integrating redistribution, recognition, and participation in professional education. Full article