Search Results (4,807)

Background: Despite the availability of safe vaccines, Ethiopia’s human papillomavirus (HPV) vaccine uptake remains suboptimal, particularly among out-of-school girls (OOSGs). This study examines the effect of multi-channel demand generation messages in two districts to determine which interventions most effectively improve uptake. Methods: A convergent mixed-methods design was employed across four districts in the Somali and South Ethiopia regions, with Jigjiga and Derashe serving as intervention sites and Gode and Kolango Zuria as controls. For the quantitative component, 950 sample households were recruited using cluster sampling. The qualitative inquiry involved 27 in-depth interviews (IDIs) and 16 focus group discussions (FGDs) within the intervention sites. Results: A total of 950 caregivers and 1134 girls completed the survey. Awareness was significantly higher among caregivers (AOR: 4.42; 95% CI: (3.06, 6.39)) and girls (AOR: 7.63; 95% CI: (3.49, 16.67)) in intervention sites, as well as among in-school girls (AOR: 13.46; 95% CI: (4.09, 41.90)). The mean vaccination coverage reached 71%, with significantly higher rates in intervention sites (AOR: 4.07; 95% CI: (2.29, 7.23)) and among in-school girls (AOR: 47.16; 95% CI: (20.23, 109.9)). Interpersonal communication—via teachers, peers, community health workers and vehicle-mounted promotion—was more effective in influencing awareness, attitude and uptake. Barriers for OOSGs included limited access to vaccination sites, low campaign awareness, misconceptions and gender-related issues. Conclusions: Appropriate demand generation strategies effectively enhance HPV awareness and vaccine uptake, yet a significant equity gap remains, as only one-third of OOSGs received the vaccine compared with 85% of in-school girls. Targeted interventions are recommended for OOSGs focused on both access to service and context-specific demand creation to address this disparity. Full article

Purpose: This study aims to evaluate the ability of radiomic features obtained from technetium-99m dimercaptosuccinic acid (Tc-99m DMSA) planar images to distinguish renal cortical uptake patterns among patients with chronic kidney disease (CKD). We also assessed the association between selected radiomic features and progressive renal function loss during follow-up. Methods: The study included a total of 185 patients: patients with Diabetes mellitus (DM) + hypertension (HTN) diagnosis (Group 1, n = 30), patients with HTN diagnosis alone (Group 2, n = 86), and patients with no history of DM or HTN who were followed for CKD (Group 3, n = 69). Intergroup comparisons were performed using the Kruskal–Wallis test with Bonferroni-corrected post hoc pairwise testing; the proportion of significantly different features was assessed using FDR correction. As a secondary exploratory analysis, the relationship between selected radiomic features and time to first observed ≥20% eGFR decline at follow-up was evaluated using univariate L2-penalised Cox proportional hazards regression with feature selection guided by the events-per-variable principle and model discrimination quantified using Harrell’s C-index. Results: Intensity Kurtosis values showed a statistically significant difference among the groups: −0.11 (−0.31 to 0.12) for Group 1, −0.24 (−0.41 to −0.04) for Group 2, and −0.33 (−0.45 to −0.16) for Group 3 (p = 0.001). Mean Intensity values were found to be 60.66 (31.01–89.39) in Group 1 and 90.46 (72.87–106.34) in Group 3 (p < 0.001). Age, gender, and baseline eGFR did not differ between groups. Radiomic analysis revealed significant intergroup differences predominantly in intensity- and texture-based features, while morphological features showed more limited differentiation. In the secondary exploratory longitudinal analysis, Centre of Mass Shift was the only morphological feature significantly associated with time to first observed ≥20% eGFR decline at follow-up (HR per SD: 0.74; 95% CI: 0.58–0.94; p = 0.015; C-index: 0.57). Conclusions: Radiomic features from Tc-99m DMSA planar images reveal quantitative differences between clinically defined CKD subgroups even when cortical uptake appears visually indistinguishable. The threshold-specific association of Centre of Mass Shift with subsequent eGFR decline, beyond baseline renal function, suggests that DMSA radiomics may provide exploratory prognostic information that warrants prospective validation. Full article

Background/Objectives: Attitudes toward health conditions involving physical dysfunction may differ between healthcare professionals (HCPs) and the general public. This study compared affective responses to stroke, femoral neck fracture (FNF), and spinal cord injury (SCI) across both groups within a unified framework. Methods: We conducted an online cross-sectional survey of 400 members of the general public (stratified by age and gender) and 400 HCPs representing 18 professions. Affective responses were measured using scales assessing negative affect, interpersonal avoidance, and impressions (physical strength, mental resilience, and mental strength). A 2 × 3 mixed-model ANOVA (group × condition) and correlation analyses were conducted. Results: Negative affect showed a significant group × condition interaction (p < 0.001, ηp² = 0.030). HCPs scored lower than the general public for stroke and FNF, with no significant difference for SCI. HCPs also reported lower interpersonal avoidance across all conditions. Impression scales showed no interaction; however, HCPs rated higher physical strength and mental strength, while mental resilience showed no group difference. Condition effects were significant, with a consistent hierarchy of SCI > stroke > FNF for both negative affect and interpersonal avoidance. Negative affect and interpersonal avoidance were moderately correlated in both groups. Among HCPs, FNF-related interpersonal avoidance negatively correlated with years of clinical experience. Conclusions: HCPs generally report less negative affect and interpersonal avoidance and hold more positive perceptions of patient capability than the general public. However, both groups share a negativity hierarchy across conditions, suggesting persistent perceptions associated with specific health labels. Full article

Investigating the influence of women’s family status on farmers’ adoption of digital and intelligent production transformation holds significant value in bridging the gender gap in research on modern agricultural production transformation and in facilitating the digital and intelligent transformation of the agricultural sector. Drawing on survey data from Henan Province collected through a household survey conducted in July 2024 by the research team, which employed a combination of stratified and random sampling, and focusing on farmers’ adoption of plant protection drone technology, this paper employs the Triple-Hurdle model to examine the impact of women’s family status on farmers’ digital and intelligent production transformation decisions and the underlying mechanisms. The baseline regression results show that the improvement of women’s family status facilitates farmers’ digital and intelligent production transformation decisions. Specifically, it enhances farmers’ willingness to adopt digital and intelligent production transformation, promotes their adoption behavior of plant protection drone technology, and increases the degree of adoption of such technology. The mechanism analysis reveals that the improvement of women’s family status promotes farmers’ digital and intelligent production transformation decisions by increasing their satisfaction with the institutional environment. The heterogeneity analysis of household characteristics indicates that women’s family status has a greater facilitating effect on the willingness of farmers with lower female labor force participation and those with heavier child or elderly dependency burdens to undergo digital and intelligent production transformation. The heterogeneity analysis of village environmental characteristics shows that women’s family status has a greater facilitating effect on the willingness and behavior of farmers in villages with a larger number of technical personnel to undergo digital and intelligent production transformation. Additionally, it has a greater facilitating effect on the willingness of farmers in villages with a stronger culture of gender equality to undergo such transformation. Using plant protection drone adoption as an example, this paper provides preliminary evidence of the positive impact of women’s family status on the digital and intelligent transformation of agriculture. However, due to the inherent limitations of cross-sectional data, our exploration of the dynamic process of transformation remains inadequate. Therefore, future research is warranted to employ longitudinal panel data to further validate the findings of this study. Full article

Background: Transgender and gender expansive (TGE) people experience high rates of interpersonal victimization, which has been linked to high rates of post-traumatic stress disorder (PTSD, a highly disabling and under-studied mental illness among TGE people). This systematic review identifies, classifies, critically appraises, and synthesizes the peer-reviewed literature describing the association between interpersonal victimization and post-traumatic stress among TGE people. This review collates what is known about the associations between victimization and PTSD among TGE people and makes recommendations to guide future research and intervention development. Methods: Searches were conducted across five databases (PubMed, Embase, Web of Science, PsycInfo, and CINAHL) following PRISMA guidelines. Inclusion criteria were: English language; peer-reviewed original research; articles describing the association between victimization and PTSD among TGE youth or adults; reporting TGE-specific data. Exclusion criteria were: reviews, commentaries without original data, dissertations or theses, conference abstracts, animal studies, studies without TGE-specific findings, and case studies. Quality appraisal was completed for all studies, which included a discussion of bias. Data extraction was completed by two independent authors, and conflicts were resolved by a third. Data were stratified by gender identity, race or ethnicity, and type of violence for further synthesis. Results: 25 studies were evaluated for design, measure quality, and key findings. Findings were highly consistent across studies: multiple forms of interpersonal violence (e.g., childhood maltreatment, sexual violence, intimate partner violence, and transgender-specific victimization) were significantly associated with PTSD symptom severity or diagnosis across diverse identities and geographic contexts. All studies examining childhood sexual abuse reported significant associations with PTSD outcomes, highlighting early life as a critical period of vulnerability. Samples were disproportionately White and adult, with limited examination of intersectional experiences shaped by race, ethnicity, and socioeconomic status. Discussion: Interpersonal violence-related PTSD among TGE populations reflects a pervasive and systemic pattern of trauma rooted in structural discrimination rather than isolated individual risk. Addressing this inequity requires multilevel prevention and intervention strategies. Future research should prioritize longitudinal designs, culturally responsive measurement tools, and intersectional analyses to inform prevention, clinical care, and policy responses. The majority of studies were cross-sectional designs, so causality cannot be inferred. Additionally, the samples were disproportionately White and adult, which may bias the magnitude of associations reported and limit generalizability to racially and ethnically diverse TGE populations. Although many studies reported race and ethnicity descriptively, none disaggregated violence-related PTSD outcomes by racial or ethnic group within TGE samples, representing a critical limitation for intersectional analysis. Full article

Objectives: Educational attainment appears to be associated with non-alcoholic fatty liver disease (NAFLD). The inconsistent findings across existing studies necessitate a thorough meta-analysis to elucidate this association. Methods: A systematic search of PubMed, Web of Science, and Scopus was conducted from inception to 31 December 2024, without language restrictions. Data were analyzed using Review Manager 5.4, with pooled odds ratios (ORs) and 95% confidence intervals (CIs) estimated via appropriate models. Results: 27 studies involving 446,312 participants (93,116 NAFLD; 353,196 healthy individuals) were included. Noteworthy heterogeneity was detected, with I² = 96% for more-than-high-school and I² = 95% for high-school-education when we pooled all the studies together. Further subgroup analyses suggested that higher education was inversely associated with NAFLD risk in some developed countries, like the United States, while potential gender-specific effects were found among the Chinese population. Conclusions: The current meta-analysis suggests that the association between educational attainment and NAFLD is complex and context-dependent, and it may vary across different countries and types of sex. Full article

In the field of human–robot interaction (HRI), researchers have extensively examined the role of social robot characteristics and how these can influence human–robot relationships. In particular, the robot’s voice is one of the most studied aspects, with numerous studies focusing on specific features such as tone, frequency, pitch, and gender. The robot’s voice represents a powerful social signal, whose design can influence people’s affective evaluations and acceptance of robots. With regard to language, however, relatively few studies have investigated the role of a robot’s accent (native or foreign). This experimental study therefore explores the influence of native accent on trust in robots. The study was conducted on two different samples: 60 Italian participants and 37 Arabic participants. Participants listened to two robot presentations in their native language: one delivered with a native accent and the other with a foreign accent. After listening to both presentations, participants were asked to indicate which robot they trusted. The results showed a 77.3% preference for the robot speaking with a native accent, compared to 22.7% for the robot with foreign accent. These findings demonstrate that, regardless of the language (Italian or Arabic), accent significantly influences the choice to invest trust in the robot, supporting the similarity-attraction effect. Accent calibration thus emerges as a low-cost, high-impact parameter in socially assistive and commercial robotics. Since accent influences trust-based delegation, voice design should be strategically adapted in service, healthcare, education, and customer-facing contexts. Full article

While substantial literature exists on COVID-19’s effects on businesses, long-term recovery strategies and support systems for informal female-owned enterprises in secondary cities are underexplored. The study sought to qualitatively examine the gendered impacts of COVID-19 on informal food businesses owned by women in Kenya. Qualitative interviews with 80 participants, including key informant interviews, in-depth interviews, and focus group discussions in Kisumu, Kenya, were conducted. The study found that the pandemic significantly disrupted the livelihoods of female vendors, leading to changes in the market and household organization, including gender specific transformations. The women adopted some individual and collective strategies as part of the post-pandemic recovery strategies to enhance their resilience in business. The study findings shed light on the vulnerabilities of informal food businesses in secondary cities to emergencies and the need for targeted policies to support informal economies during crises. Full article

Although Vietnam is committed to complying with international frameworks on gender equality such as CEDAW, the Beijing Platform, and the 2030 Agenda, women still face many barriers in exercising their land use rights in practice. This study uses a doctrinal legal research method combined with comparative analysis to: (i) systematically analyze the provisions on gender equality in the 2024 Land Law; (ii) compare these provisions with the 2013 Land Law and relevant international standards; and (iii) assess the challenges in implementation from the perspective of substantive equality. The results show three notable areas of progress: (1) gender equality is recognized for the first time as a specific right of land users; (2) gender discrimination is included in the list of prohibited acts in land management and use; and (3) the scope and procedures for joint land use rights certification for spouses are clarified. However, gaps in legislative drafting, enforcement mechanisms, and the persistence of patriarchal social norms continue to widen the gap between equality on paper and equality in practice, as evidenced by the persistent 32% proportion of certificates registered solely in men’s names with no updated official data released nearly four years later; the absence of specific sanctions for gender discrimination in land use under Decree 123/2024/ND-CP; and the lack of mandatory enforcement mechanisms for joint spousal certification under the 2024 Law’s implementing regulations. Based on this, the article proposes several recommendations to improve the law and strengthen enforcement mechanisms to better align with CEDAW and SDG 5.a standards. Full article

Background: Health-related quality of life (HRQoL) in adolescents reflects their perception of physical, psychological, and social well-being within a specific cultural context, considering developmental stage and individual differences. The KIDSCREEN-27 is a self-report instrument designed to assess HRQoL in children and adolescents, with demonstrated validity and reliability in international samples. Objective: To examine the psychometric properties (i.e., reliability, construct validity, convergent and discriminant validity, and measurement invariance) of the KIDSCREEN-27 questionnaire in a sample of Mexican adolescents. Method: A cross-sectional study was conducted with a sample of 1124 Mexican adolescents aged 10–17 years (M = 13.37, SD = 1.08; 53.5% female; 83.6% secondary education) obtained through non-probabilistic convenience sampling. Reliability (Cronbach’s α, McDonald’s ω), structural validity through exploratory (AFE) and confirmatory factor analyses (CFA), measurement invariance by gender, and convergent and discriminant validity via correlations with self-esteem, well-being, stress, and anxiety–depressive symptoms were evaluated. Results: Analyses showed strong internal consistency (α = 0.912, ω = 0.914). EFA supported a five-dimensional structure. CFA showed an optimal fit after including specific covariances (χ²/df = 3.62, RMSEA = 0.048, CFI = 0.929, TLI = 0.919, SRMR = 0.043). Metric and scalar gender invariance were supported. Positive correlations emerged with well-being (r = 0.76, p < 0.01), self-esteem (r = 0.64, p < 0.01), and satisfaction with life (r = 0.52, p < 0.01), and negative correlations with stress (r = −0.61, p < 0.01), academic stress (r = −0.32, p < 0.01) and anxiety–depressive symptomatology (r = −0.53, p < 0.01), providing evidence of convergent and discriminant validity. Conclusions: The KIDSCREEN-27 demonstrated adequate psychometric properties, supporting its use among Mexican adolescents, enabling the identification of well-being needs, monitoring of interventions, informed decision-making in health and educational practice and supporting cross-cultural comparisons of adolescent well-being. Full article

Background: Understanding how demographic and clinical factors influence SARS-CoV-2 infection patterns, vaccination uptake and disease outcomes in community settings is essential for effective primary care-based public health planning. Objectives: This study aimed to investigate the distribution of SARS-CoV-2 infections among adults attending Primary Healthcare (PHC) facilities in Giannitsa, Greece, from 2020 to 2024, and to examine associations between demographic and clinical characteristics, vaccination category and disease outcomes. Methods: A retrospective analysis was conducted using data from the National Registry of Patients with COVID-19. The study included 1144 adults diagnosed with SARS-CoV-2 at PHC facilities from 19 November 2020 to 3 October 2024; all cases included in the present analysis had been confirmed by rapid antigen testing. Variables included age, gender, residence, registry-recorded underlying medical conditions, vaccination category, seasonality and clinical outcome. Results: Significant shifts in case distribution were observed across time, with younger adults predominating in 2020–2022 and older adults (61–90 years) in 2023–2024 (p < 0.001). Winter months showed higher case incidence overall (p < 0.001). Vaccination coverage increased annually, reaching 84.8% in 2024 (p < 0.001). Hospitalization/death occurred in 1.7% of patients and was strongly associated with age ≥61 years (6.0% vs. 0.3%), the presence of at least one registry-recorded underlying medical condition (9.2% vs. 0.9%) and vaccination category; specifically, hospitalization/death occurred in 10.4% of individuals diagnosed during the pre-vaccine period, 2.3% of unvaccinated individuals during the vaccination era and 0.9% of vaccinated individuals (all p < 0.001). Conclusions: Older age, underlying medical conditions and a lack of vaccination were key predictors of worse outcomes. The findings underscore the importance of strengthening vaccination outreach and targeted PHC interventions, particularly for high-risk and rural populations. Full article

Higher education institutions (HEIs) play a central role in fostering sustainability competencies to address environmental challenges. Within Education for Sustainable Development (ESD) and Sustainable Development Goal (SDG) 4 frameworks, universities must cultivate not only knowledge but also attitudes and behaviours promoting environmental responsibility. This study examines environmental attitudes as sustainability learning outcomes among undergraduate students, analysing differences by gender, age, and discipline in six Andalusian universities. Sustainable Education is defined as an approach integrating environmental, social, and economic sustainability dimensions into teaching to develop active competencies for sustainable development. A cross-sectional survey (n = 1471) used the validated CASEM questionnaire (see previous validation studies) to assess environmental knowledge, environmental education knowledge, and pro-environmental behaviour. The results show significant differences: women outperformed men across all dimensions, students aged over 25 exhibited stronger profiles, and Education Sciences students outperformed Engineering students. A persistent knowledge–behaviour gap emerged, especially in technical fields. These findings reveal curricular inequalities in sustainability integration. Mandatory, discipline-specific ESD—particularly in engineering—may help bridge these gaps and enhance uniform learning outcomes. By employing a multidimensional instrument and stratified sample, this study offers robust evidence of structural disparities, informing policy for equitable Higher Education for Sustainability. Full article

This study developed and validated a curriculum-aligned instrument to assess preservice primary teachers’ geometric reasoning skills. Addressing the limited availability of domain-specific tools in teacher education research, the study examined preservice teachers’ conceptual strengths and weaknesses across key geometry domains relevant to primary mathematics teaching. A two-phase quantitative research design was employed. In Study 1, Confirmatory Factor Analysis (CFA) and Item Response Theory (IRT) were used to evaluate the psychometric properties of the instrument with a sample of 221 preservice teachers, providing evidence of construct validity and internal consistency. Geometric reasoning was conceptualised as a four-factor structure comprising Conceptualisation of Geometric Properties (GP), Geometric Transformation Reasoning (GT), Reasoning with Representations of Three-Dimensional Objects (RE), and Measurement Reasoning (MS). In Study 2, the validated Geometric Reasoning Test (GRT) was administered to a larger sample of 406 preservice primary teachers from three education colleges in Myanmar. Descriptive statistics and group comparisons were conducted using Welch’s t-tests and Welch’s ANOVA to examine differences by gender, year level, and institution. The findings indicate that preservice primary teachers’ geometric reasoning remains underdeveloped across training stages, highlighting the need for greater emphasis on geometry and spatial reasoning in teacher education. Full article

Given South Korea’s acute land constraints and ambitious renewable energy targets, floating solar farms (FSFs) on multi-purpose dam reservoirs offer a sustainable land-sparing solution for advancing the water-energy nexus and climate adaptation. This study estimates households’ willingness to pay (WTP) for a tariff premium supporting FSFs on multi-purpose dam reservoirs—a bundled sustainability attribute encompassing land-sparing deployment, water-energy nexus synergies (90% evaporation reduction, hydropower complementarity), and avoided land-use conflicts—relative to equivalent electricity from land-based solar farms (LSFs). The valuation scenario explicitly frames FSFs as an integrated policy package, not an isolated engineering characteristic, with balanced disclosure of location-specific trade-offs. The study highlights the sustainability value of land-sparing water-energy nexus solutions in South Korea. The analysis draws on a nationwide contingent valuation survey of 1000 households conducted from mid-April to mid-May 2025. Employing the one-and-one-half-bound dichotomous choice format with a spike model to handle zero WTP responses, we estimate a mean tariff premium of KRW 26.8 (USc 1.9) per kWh—17% of the residential rate. This exceeds the current FSF-LSF levelized cost differential (KRW 19 per kWh), despite 49% zero bids largely from protest responses. Socioeconomic factors (education, income, female gender, metropolitan residence, policy awareness) significantly shape acceptance probabilities. These findings affirm meaningful support for FSF deployment, contributing to long-term sustainability by integrating renewable energy with water resource management and reducing land-use conflicts. They also inform sustainable energy transition policies by showing that consumers are willing to fund multifunctional infrastructure synergies. Full article

The possibility of G-induced loss of consciousness (G-LOC) is a key concern when flying modern, high-performance aircraft. Currently, there are no identification methods available based on physiological data. This study aimed to determine whether specific pulse wave changes could be reliably identified using automatic computer algorithms to detect impending G-LOC. The pulse waves of 86 people who experienced G-LOC in a human centrifuge were analysed alongside an age-, gender-, nationality-, training-, and anti-G-equipment-matched control group using computer algorithm methods to analyse possible longer reductions in the G-LOC group. Based on this data, the study showed that centrifuge profiles with a gradual “onset run” using AGSM resulted in longer pulse wave flattening around the G-LOC in the G-LOC group than in the matched control group. However, this could not be verified in human centrifuge runs with active flight profiles and higher onset rates. Unfortunately, this means that the method used here would not currently be applicable in actual flight. In the future, the possibility of creating an identification method could be extended by incorporating additional physiological data. Full article