Search Results (5,527)

Background/Objectives: Childhood obesity remains a critical public health concern in Greece, particularly among socioeconomically vulnerable groups. This study conducted a secondary analysis of five large-scale epidemiological datasets to examine the association between energy balance-related behaviours (EBRBs) and obesity in children in need. Methods: Data were compiled from five nationally or regionally representative studies (Genesis, ToyBox, Healthy Growth, ENERGY, and Feel4Diabetes) involving children aged 1–12 years. Stratified and subgroup analyses were performed to examine associations between weight status and EBRBs, including dietary habits, physical activity, and sedentary behaviour. Determinants of EBRBs were also analysed using the socio-ecological model framework. Results: Children in need demonstrated a higher prevalence of overweight and obesity compared to the general child population. Key risk factors for EBRBs included frequent consumption of sugar-sweetened beverages, sweet snacks, and high screen time. Protective behaviours associated with lower obesity risk included regular breakfast consumption, adequate sleep duration, and physical activity. Determinants of high-risk EBRBs were primarily interpersonal and, to a lesser extent, individual and community-level factors. Conclusions: These findings highlight the disproportionate burden of childhood obesity among vulnerable populations and identify modifiable behaviours and determinants that can inform targeted interventions. These results provide a robust evidence base to guide national public health policies, including the development of school- and community-based obesity prevention programmes aligned with the goals of Greece’s National Action Against Childhood Obesity. Prioritising children in need in such initiatives is essential to reduce health inequities and improve long-term health outcomes. Full article

This paper presents an integrated approach to social network analysis that combines graph theory, social network analysis (SNA), and Shannon’s information theory, applied to a real-world Twitter network built around the political hashtag Zandberg. Unlike studies based on synthetic data, our analysis leverages empirical content from a live political discourse. We employ classical centrality measures (degree, betweenness, closeness), local clustering coefficients, and community detection using the Louvain algorithm. A key theoretical contribution is the introduction of a novel metric: the Structural Entropy Index of a Community (SEIC), which quantifies internal decentralization of communication independently of community size. The analysis reveals significant variation in community structures and entropy levels. Larger communities tend to be decentralized (SEIC > 0.8), while smaller groups are often dominated by single influential nodes. These findings have practical implications for influencer identification, disinformation resilience assessment, and communication strategy optimization. The proposed methodological framework provides a robust tool for studying the structural and informational dynamics of real-world social networks in digital environments. Full article

Environmental DNA (eDNA) has become a promising tool for phytoplankton surveys. However, the accuracy of eDNA-based detection is related to primer selection across diverse environments, and optimal primer pairs selection on phytoplankton community in human impacted ecosystems is still lacking. The aim of this study is to evaluate how primer selection shapes phytoplankton community profiles by eDNA biomonitoring diverse anthropogenically disturbed aquatic systems (rivers, reservoirs, and seas). Four primer pairs targeting the 18S rRNA (V9-1 and V9-2), chloroplast rbcL, and ITS regions, were explored and our results revealed that primer choice critically governed the accuracy of phytoplankton profiling. Significant variations in annotated phytoplankton eDNA sequences in different groups of primer pairs were observed, where the primers 18SV9-1 and rbcL demonstrated superior specificity, amplifying >90% of phytoplankton OTUs. 18S-targeted primers detected the highest species richness, while the ITS primer showed the lowest. Alpha diversity was highest and most consistent for 18S primers. Beta diversity ordination (nMDS/Bray–Curtis) further highlighted primer-dependent community structuring in which 18S primers effectively clustered reservoir and marine samples separately, whereas primer rbcL discriminated habitat-specific signatures across three ecosystems. The primer ITS failed to distinguish among different habitats. Overall, our data demonstrated the critical role of primer optimization in eDNA-based phytoplankton studies, and could provide methodological guidelines for the design of effective monitoring protocols in rapidly urbanizing aquatic systems. Full article

The Triarchic Psychopathy Measure (TriPM) is based on a three-dimensional conceptual model, though structural analyses of the TriPM items indicate that they do not reflect this conceptual model. In contrast, studies have shown that multiple factors are required to account for all the TriPM items in community and incarcerated samples. More problematic is that some of these factors are outside of the nomological network of psychopathy. In contrast, there are empirically robust findings supporting the four-factor model of psychopathy, irrespective of sample type, assessment method, or item set. For the current study, a structural equation modeling approach was utilized with incarcerated and community samples to demonstrate that theoretically relevant candidate items from the TriPM could be employed to represent the four-factor model of psychopathy (i.e., four-factor proxy measure—4FPM). Multiple group confirmatory factor analysis of the 4FPM items provided evidence of strong (scalar) invariance across community and incarcerated samples. Finally, associations with external correlates and other psychopathy scales highlighted that the 4FPM can be utilized to represent the four-factor model of psychopathy. Full article

Impairments of executive function following acquired brain injury including stroke (ABI) contribute significantly to long-lasting everyday difficulties in life. Pilot work on the CO-OP Approach^TM (Cognitive Orientation to daily Occupational Performance Approach), a contextualized strategy training intervention, with ABI adults with executive dysfunction showed improved performance on untrained everyday life tasks and cognitive flexibility. Objective: Our objective was to determine the efficacy of the CO-OP Approach relative to usual occupational therapy (UOT) for community-dwelling adult survivors of ABI with executive dysfunction. Methods: Eighty-seven participants were randomized to receive CO-OP (n = 45) or UOT (n = 42) in their homes. All participants identified five personally meaningful, everyday life goals (using the Canadian Occupational Performance Measure (COPM)) and received up to 15 one-hour treatment sessions twice per week. Three goals were trained, and two were untrained. Interventions were provided by occupational therapists registered with their regulatory college. The CO-OP group was trained to apply a meta-cognitive strategy to three goals. The UOT group received therapy based on the clinicians’ (experienced in community settings) determination. Testers were masked to the participants’ group. Analysis at the primary outcome (Post-test, ~10 weeks following baseline) was on an intent-to-treat basis. Results: Participants in the CO-OP group had a mean age of 57.5 years, a mean time post-ABI of 5.3 years, and were 57.8% men. Those in the usual OT group had a mean age of 54.7 years, a mean time post-ABI of 6.2 years, and were 69.0% men. The CO-OP group reported statistically significant higher improvements on COPM performance and satisfaction scores post-test for untrained and trained goals. However, these benefits were not retained at follow-up (three months post-baseline). Conclusions: The CO-OP Approach^TM shows promise for improving performance in everyday life goals for individuals with chronic ABI relative to usual community occupational therapy. Achieving retention of these benefits remains a challenge. Full article

In the local development field, it is important to have tools and instruments—methodologies—that make it possible to determine and evaluate the potential of each territory in order to be able to face future socioeconomic development processes. In view of the lack of such specific methodologies based on evidence and scientific rigour, the aim of this article is to address this need from two perspectives: on the one hand, through its practical application by administering the READI^® matrix and its computer application—@plicaREAD—in eight counties in Valencia province (Spain); on the other hand, after the fieldwork, the aim is to determine a proposal for interpretation of the scenarios resulting from this application—scores—obtained through a Group of Local Development Experts who have implemented this matrix in other Spanish territories (Alicante, Castellón, Murcia, Albacete, Cuenca and Teruel), with the intention of presenting it to the scientific community for discussion. As a conclusion of the results, the proposal presented investigates more deeply into the search for methodologies for territorial development planning, based on the progress of a tool available for this purpose, the READI^® matrix, from an integral, integrated and integrating vision. Full article

Background: Older adults (≥65 years) account for a substantial share of Emergency Medical Service (EMS) activations, yet differences between nursing homes (NHs) and the community are insufficiently defined. This study aimed to compare EMS responses for older adults inside and outside NHs. Methods: We conducted a retrospective observational study of all EMS activations involving patients ≥65 years in a rural German region from July 2020 to March 2025, based on fully anonymized prehospital patient care reports electronically documented on tablets. Prehospital patient care was assessed using the ABCDE approach, with additional analysis of feedback codes transmitted to the control center (response and on-scene times, physician dispatch, lights and sirens use, feedback codes, hospital destination, and admission urgency). Continuous variables were summarized as mean (SD) or median [IQR], categorical variables as n (%), and group comparisons performed using the Chi-Square test or Fisher’s exact test (categorical) and the t test or Mann–Whitney U test (continuous), as appropriate. Results: Among 46,598 EMS activations in adults aged ≥65 years, 28,749 EMS responses were included in the analysis after excluding non-emergency transports and duplicate physician records. Of these, 20% occurred in NHs (5707/28,749) and 80% in the community (23,042/28,749). Median age was 85 years (IQR 80–89) in NH patients and 80 years (IQR 73–86) in community patients (p < 0.001). Females accounted for 60% (3450/5705) of NH patients and 53% (12,223/23,036) of community patients (p < 0.001). Emergency physicians were dispatched in 7% of NH incidents (392/5707) and 10% of community incidents (2327/23,042; p < 0.001). In NHs, bronchitis/pneumonia was a leading feedback code (6%, 354/5707), whereas in community patients, acute coronary syndrome (ACS) was prominent (5%, 1249/23,042). Admission urgency categories also differed significantly, with NH residents classified as category 3 (outpatient evaluation) in 11% (621/5706) and category 0 (no admission) in 5% (280/5706), whereas community patients were more often classified as category 1 (immediate intervention) in 13% (2886/23,037) (all p < 0.001). Conclusions: NH residents were older, more often female, and presented with low-to-moderate acuity. Frequent diagnoses were closed extremity injuries and bronchitis/pneumonia. In contrast, ACS and other cardiovascular emergencies were more common in the community, particularly among men, consistent with international evidence on sex-specific incidence. NH residents were more often classified as non-urgent or outpatient and transported to nearby hospitals, whereas community patients more frequently required immediate intervention and referral to tertiary centers. In summary, EMS responses for older adults differed in clinical presentations, operational patterns, and hospital pathways. Full article

Binge drinking (BD) is defined as a pattern of alcohol consumption that results in a blood alcohol concentration of 0.08 g/dL or higher, typically achieved after consuming approximately 70 g of pure alcohol (about five drinks for men) or 56 g (about four drinks for women) within roughly two hours. It is highly prevalent among adolescents and young adults and has significant physical, psychological, and social consequences. Despite numerous interventions to reduce BD, there is limited systematic evidence on their effectiveness. This study presents a systematic review of randomized controlled trials (RCTs) evaluating interventions to reduce BD, focusing on their impact on frequency, intensity, and associated physical, psychological, or social outcomes. The review followed PRISMA 2020, and the protocol was registered with PROSPERO (CRD42024623481). A comprehensive search was conducted in multidisciplinary and specialized databases. Included studies were RCTs targeting BD in clinical or community populations of any age. Non-empirical and observational studies, or studies not specifically focused on BD were excluded. The risk of bias was assessed using RoB 2, and a total of 21 studies (N = 14,754 participants) were included, showing high variability in design, format, and theoretical basis. Brief, individual digital interventions predominated, although face-to-face group and multimodal interventions proved more effective. Eleven studies reported significant reductions in BD frequency or prevalence; fewer addressed intensity. Interventions based on motivational and cognitive behavioral approaches, especially in structured programmes with prolonged follow-up, were the most effective. Improvements were observed in psychosocial variables (e.g., negative consequences, self-efficacy, expectations, social norms, and intention to consume), but not in physical health or consumption of other substances. Most studies had a moderate risk of bias, and few demonstrated long-term effects. More robust, comparative, and longitudinal studies are needed. Full article

Background: Medication safety in pregnancy, puerperium, and perinatal periods is underexplored because these populations are excluded from clinical trials. EudraVigilance offers post-marketing evidence, but disproportionality analyses focus on isolated drug event pairs and may miss syndromic patterns. We applied a network- and cluster-based framework to EudraVigilance reports on antiviral use in pregnancy to improve surveillance and identify meaningful constellations. Methods: We retrieved all individual case safety reports (ICSRs) from January 2015 to June 2025, including pregnancy, puerperium, or perinatal terms, focusing on suspect antivirals. After parsing terms, disproportionality metrics were computed as a benchmark. A bipartite drug–event network was built and projected to event–event co-occurrence networks; Louvain community detection identified clusters. Clusters were characterized by size, drug mix, seriousness, overlap with disproportionality signals, and stratification across periods. Results: The dataset comprised 106,924 ICSRs and 232,067 unique pairs. Disproportionality yielded 6142 signals, mainly involving antiretrovirals (ritonavir, lamivudine, zidovudine, emtricitabine/tenofovir). Network analysis revealed clusters grouping maternal and fetal/neonatal outcomes (e.g., fetal death, low birth weight), and transplacental transfer, highlighting structures not visible in pairwise analyses. Several clusters combined high-frequency exposures with clinically relevant outcomes, suggesting early-warning potential. Conclusions: Combining disproportionality with network- and cluster-based pharmacovigilance adds value for monitoring pregnancy medication safety. Beyond individual signals, this approach reveals meaningful clusters and “bridge” reactions connecting adverse-event domains, offering a richer framework for perinatal surveillance. Despite spontaneous-reporting limits, findings generate hypotheses for mechanistic and pharmacoepidemiologic follow-up and support network methods as complements to traditional pharmacovigilance. Full article

Bike lending offers a service that enables individuals to borrow bicycles for short-term use (i.e., ranging from 2 hours to 36 months), typically from designated locations within cities, campuses, or communities. Unlike bikesharing systems that typically rely on automated kiosks and/or undocked and free-floating devices for public access, bike lending involves a managed program with staff, similar to a library model. These programs can be administered by community organizations, bike shops, public libraries, and other local entities. They are typically community- or membership-based, with many programs associated with non-profit organizations or publicly owned and operated. In this paper, we investigate bike lending in the United States and Canada as of Spring 2024, including a literature review, the identification and characterization of bike lending programs (n = 55), expert interviews (n = 24), a survey of bike lending operators (n = 31), and 2 focus groups with a total of 12 participants. Insights from expert interviews and operator surveys highlight the experiences of professionals involved in bike lending. The focus groups capture the experiences of bike lending users. This paper finds that North American bike lending is often tailored to the specific needs of communities, such as youth, low-income individuals, and the general population. More sustained funding could support program expansion and diversify bike offerings. Enhancing cycling infrastructure, such as adding dedicated bike lanes and paths, could improve overall cycling safety and increase participation in bike lending programs. This study’s findings could help strengthen existing bike lending programs, guide the development of new initiatives and supportive policies, and enhance safe bicycle use for participants. Full article

Aim: Post-COVID condition (PCC) is largely considered the biggest public health emergency in recent times. The role of exercise therapy in PCC is currently unknown, and evaluative studies are currently lacking in this area. This study therefore aimed to evaluate the effects of a football club community trust exercise rehabilitation programme on physical function and quality of life in individuals with PCC. Method: A mixed-methods retrospective design was employed, utilising a framework to assess the programme’s reach, effectiveness, adoption, implementation, and maintenance (RE-AIM). Quantitative data (questionnaires and physiological assessments) were collected at baseline, 6 weeks, and 12 weeks during the programme, and at 6 months post-intervention (n = 7). Qualitative data were gathered through semi-structured focus groups at week 12 (n = 7) and 12 months (n = 5) post-intervention. Quantitative data and qualitative data were analysed using repeated measures ANOVAs and thematic analysis, respectively. Results: The programme led to significant improvements in physical function, including increased six-minute walking distance (6MWT, p < 0.001), one-minute sit-to-stand repetitions (1MSST, p < 0.035), and lung function (spirometry; MIP: p = 0.048, MEP: p = 0.024). Participants also reported enhanced QoL (HRQoL-14, p = 0.004), reduced anxiety (GAD-7, p = 0.008) and depression (PHQ-9, p = 0.008), and increased confidence and self-efficacy. The programme was well-received, with participants valuing the supportive environment and personalised approach. Conclusions: Football community trust exercise rehabilitation programmes can effectively improve physical function and quality of life in individuals with PCC, offering a promising model for community-based rehabilitation. Further studies are needed with larger sample sizes to assess the scalability of similar programmes. Full article

In multi-UAV cooperative tasks, dynamic communication topologies and resource heterogeneity present significant challenges for distributed task allocation, leading to high communication overhead and poor task-resource matching, which in turn increases computational costs. While the Consensus-Based Bundle Algorithm (CBBA) offers a robust decentralized framework, its scalability and adaptability in heterogeneous, large-scale scenarios are limited. To overcome these issues, this paper introduces a novel Two-Level Clustered CBBA (TLC-CBBA). In the first-layer clustering, UAVs are grouped based on communication topology using graph-theoretic centrality measures to rank node importance, followed by clustering based on shortest-path distances to minimize communication costs. In the second-layer clustering, a resource-balanced and distance-aware K-medoids algorithm is applied within each subgroup obtained from the first-layer clustering, taking into account UAV resource heterogeneity and spatial proximity. This method ensures spatial compactness among UAVs within each subgroup while achieving a more balanced distribution of total resources across clusters. Finally, after completing the two-level clustering, each subgroup executes CBBA for local task bundling and consensus, while the cluster centers coordinate inter-cluster communication to guarantee globally consistent and conflict-free task allocation. Simulations across diverse mission scenarios and UAV team sizes demonstrate that TLC-CBBA substantially outperforms CBBA and its variants (DMCHBA, G-CBBA, and Clustering-CBBA) in terms of communication efficiency, total task score, runtime, and significance analysis. The proposed TLC-CBBA demonstrates strong robustness and scalability for heterogeneous multi-UAV task allocation in dynamic environments. Full article

Background: Obesity is a growing public health concern in Italy, with prevalence reaching 21.6% in 2022, particularly among the elderly. To address this issue, the ObeCare project was implemented to promote obesity prevention and awareness through community pharmacies. This study aimed to evaluate obesity-related knowledge, lifestyle behaviors, and risk perception among participants engaged in the ObeCare project. Methods: A survey was administered to individuals >18 years old across Italian pharmacies involved in the ObeCare initiative by trained pharmacists. A validated questionnaire assessed obesity-related knowledge, risk perception, lifestyle behaviors, demographics, clinical conditions, and Body Mass Index (BMI). A multinomial logistic regression was implemented to identify predictors of overweight and obesity. Results: Obesity was more prevalent among men, older adults, and those with multiple comorbidities. Healthier lifestyle and greater health knowledge were significantly associated with having a normal BMI, whereas low lifestyle scores (OR 13; 95% CI 2.96–57.85) and the presence of multiple comorbidities (OR 14.79; 95% CI 8.00–27.36) were strong predictors of obesity. Individuals with obesity exhibited lower knowledge (OR 1.55; 95% CI 1.02–2.37) and risk perception. Conclusions: This study highlights the significance of lifestyle habits, knowledge, and risk perception, which will be helpful in the prevention and management of obesity. These findings support community-based education and targeted interventions, especially for high-risk groups such as men, retirees, and residents of Southern Italy. Full article

High-quality early care and education (ECE) programs, characterized by safe environments, emotionally supportive communication, proactive behavior supports, and teacher self-care practices, play a pivotal role in healthy child development. Early Childhood Mental Health Consultation (ECMHC) is an evidence-based approach designed to strengthen these environments and support young children’s social–emotional outcomes. However, the long-term impacts of ECMHC models remain understudied. Grounded in ECMHC, the purpose of this study is to evaluate the effectiveness of Jump Start Plus COVID Support (JS+CS) in supporting child psychosocial outcomes (prosocial behaviors and reduced externalizing/internalizing behaviors) over two school years. In a cluster-randomized trial, 12 ECE centers received the 14-week JS+CS intervention, and 12 attention control centers received a 14-week obesity prevention program. Children were followed over two school years to determine long-term impacts on behavior, measured by the Devereux Early Childhood Assessment (DECA) and the Strengths and Difficulties Questionnaire (SDQ). Over two school years, significant time-by-group interactions emerged for primary child outcomes. The JS+CS group showed greater improvements in DECA Initiative and Self-Regulation (p = 0.01 and p = 0.02, respectively) compared to controls. JS+CS significantly enhanced child psychosocial functioning, supporting its potential as an effective model for a scalable mental health consultation in ECE settings. Full article

Natural resource-endowed landscapes in many parts of the Global South play a crucial role in the livelihoods of communities. Such resource-endowed areas attract current and prospective resource-use actors, making them veritable hollow frontiers. Hollow frontiers, as crucial resource attractions in many parts of sub-Saharan Africa (SSA), have attracted significant interest in scientific and policy circles. While studies have explored the patterns of migration and population change around hollow frontiers, there is limited evidence on the resource-use dynamics and trajectories in hollow frontiers. This study uses the case of the Mungo Corridor of Cameroon, a hollow frontier par excellence, to (1) determine the variations in forestland resource-use practices, and (2) analyze changes in forestland resource space in the corridor. Data for this study was collected through key informant interviews (n = 37), focus group discussions (n = 15), household surveys using a structured questionnaire (n = 250), and Landsat images. Geospatial analysis, descriptive statistics, and the chi-square statistical technique were employed in the analysis. The study revealed that forestland resource-use practices (NTFPs harvesting) witnessed a significant decline due to the intensification of extraction rates. Furthermore, forestland witnessed a significant decline in Njombe-Penja and Loum (35.216% and 48.176%, respectively) between 1984 and 2024. The results provide novel insights on the pattern of resource use around hollow frontiers and further informs land management policy in the context of the regulation of land-based resources in the hollow frontiers of Cameroon and similar sub-Saharan African contexts. Future studies should explore forestland resource regeneration strategies in the Mungo Corridor. Full article