Search Results (2,469)

Background/Objectives: Problematic internet use (PIU) is a growing behavioral health concern among school-aged children. Whether health literacy and health-promoting lifestyle beliefs are associated with PIU among gifted children—a developmentally distinct population—has, to the best of our knowledge, not been investigated. Methods: A cross-sectional correlational design was used with 118 gifted students (M = 13.80, SD = 2.06) attending a Science and Art Center (BİLSEM) in İzmir, Türkiye. Data were collected using the Problematic Internet Use Scale–Adolescent Form (PIUS-A; α = 0.92), the Health Literacy for School-Aged Children Scale (HLSAC; α = 0.87), and the Adolescent Health-Promoting Lifestyle Beliefs Scale (AHPLBS; α = 0.91) in a classroom setting under researcher supervision. A three-step hierarchical multiple linear regression was performed, with age, sex, daily sleep duration, daily screen time, and weekly physical activity entered as covariates in the first step. Results: Covariates explained 24.8% of the variance in PIU (p < 0.001), with daily screen time as the strongest predictor (β = 0.36). Health-promoting lifestyle beliefs added significant incremental variance (ΔR² = 0.063, p = 0.023); health beliefs were the only statistically significant belief predictor (β = −0.24, p = 0.036), with lower health belief scores associated with higher PIU. Health literacy domains did not add statistically significant incremental variance (ΔR² = 0.028, p = 0.495), and no individual domain was a statistically significant predictor. Conclusions: Within the constraints of a cross-sectional design, health beliefs appear to play a more prominent role than health literacy in the covariate-adjusted explanation of PIU among gifted school-aged children. School health nurses may prioritize interventions that strengthen internalized health beliefs alongside information-based education, contributing to more equitable, tailored school health services for this population. Full article

The increasing complexity of healthcare data ecosystems demands educational technologies capable of supporting data-intensive learning through advanced analytics, immersive interfaces, and learning analytics. This paper presents a cloud-based reference architecture and a prospective evaluation protocol for integrating Business Intelligence (BI), Extended Reality (XR), and learning analytics in health data science education. The proposed architecture is informed by a systematic literature review conducted according to the PRISMA 2020 guidelines, which screened 613 records retrieved from four databases and retained 56 studies for qualitative synthesis. The review indicates that, although BI and XR technologies have independently been associated with educational benefits, empirical evidence supporting integrated educational architectures combining BI, XR, and learning analytics remains limited, particularly in health data science education. Based on these findings, the paper specifies a layered reference architecture comprising a cloud analytics engine, an immersive visualization engine, an interoperability layer, and a learning analytics pipeline designed to support adaptive and AI-assisted educational services during subsequent implementation phases. The reference architecture is partially instantiated within the curricular unit Health Data Analysis and Visualization of the Digital Health programme at the Polytechnic University of Porto, where the BI and XR components are currently deployed and used within the course, while the interoperability middleware, learning analytics infrastructure, and AI-assisted services remain under development or are specified as architectural capabilities. To support future empirical validation, the paper also defines a comprehensive prospective evaluation protocol comprising predefined outcomes, established instruments with published psychometric properties, together with an expert-developed health data literacy assessment undergoing content validation, research hypotheses, power analysis, a statistical analysis plan, and ethical and data-governance provisions. The manuscript makes four principal research contributions: (i) a cloud-based reference architecture for BI–XR integration, (ii) a computational learning analytics pipeline specification, (iii) an interoperable system design for health data science education, and (iv) a prospective evaluation protocol to guide the future validation of the proposed reference architecture. Full article

Background/Objectives: Dental caries remains one of the most prevalent and preventable childhood diseases worldwide. Despite universal access to free dental care in Saudi Arabia, preventable oral diseases remain common, highlighting persistent gaps in oral health literacy and preventive behaviours among children. Male students consistently demonstrate poorer oral health knowledge and practices than their female counterparts, yet they remain understudied. This study aimed to assess oral health knowledge, attitudes, and practices (KAP) among male primary school students in Al Lith city, Saudi Arabia, and to identify their associated sociodemographic determinants. Methods: A school-based analytical cross-sectional study was conducted during the 2023–2024 academic year in Al Lith city, Makkah Province, Saudi Arabia. A total of 430 male students aged 10–13 years from grades five and six were recruited via multistage cluster sampling from 8 randomly selected schools. A validated, interviewer-administered, Arabic-language questionnaire assessed knowledge (18 items), attitudes (12 Likert-scale items), and practices (12 items) related to oral health, alongside sociodemographic data. The study was designed and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Data were analysed using IBM SPSS Statistics version 27. Descriptive statistics and multivariable logistic regression were performed. Results: Of the 430 participants, 83.3% were aged 11–12 years, 89.8% were Saudi nationals, and 89.1% resided in intact, two-parent households. Knowledge deficits were widespread: only 8.4% correctly identified the recommended timing of sweet consumption, 20.2% understood dental plaque, and 28.6% recognised the protective role of fluoride. Attitudes were generally positive, with 80.1% agreeing that teeth should be brushed twice daily and 71.6% endorsing regular dental visits; however, 60.3% held that dental attendance was necessary only when pain was present. Substantial practice gaps were also evident: only 33.3% brushed for the recommended two minutes, and 12.6% had never visited a dentist. In multivariable analysis, low household income was independently associated with better oral health knowledge (adjusted odds ratio [AOR] = 2.22; 95% confidence interval [CI]: 1.04–4.74; p = 0.039), divorced parental status was independently associated with positive oral health attitudes (AOR = 5.40; 95% CI: 1.28–22.79; p = 0.022), and older age was independently associated with poorer oral health practices (AOR = 0.72; 95% CI: 0.55–0.93; p = 0.014). Conclusions: Male primary school students in Al Lith demonstrated generally positive oral health attitudes but significant deficits in knowledge and preventive practices. Comprehensive, school-based oral health promotion programmes that address key misconceptions, actively engage parents, and integrate culturally accepted practices—such as miswak use—with evidence-based preventive guidance are needed. Full article

Background: Postpartum depression (PPD) is an important maternal mental health concern. Knowledge, self-efficacy, and social support may be associated with the recognition and severity of depressive symptoms. This study assessed PPD knowledge among pregnant women/mothers and adults from the broader population in Saudi Arabia and examined the associations of self-efficacy and perceived social support with depressive-symptom scores in the maternal group. Methods: A cross-sectional online survey was conducted in Saudi Arabia from January to March 2021. Convenience and chain-referral sampling were implemented through WhatsApp. The analytical sample included 432 pregnant women/mothers aged ≥18 years and 275 broader-population participants. Arabic-language questionnaires assessed sociodemographic characteristics and PPD knowledge; the maternal-group questionnaire also assessed depressive symptoms, self-efficacy, and perceived social support. Descriptive statistics, Pearson correlations, linear regression, and one-way ANOVA were used. Results: Good PPD knowledge was observed in 73.8% of the maternal group and 77.5% of the broader-population group. Self-efficacy (r = −0.246, p < 0.001) and perceived social support (r = −0.197, p < 0.001) were negatively correlated with depressive-symptom scores. Both variables were statistically significant in the regression model; self-efficacy had the larger absolute standardized coefficient (β = −0.246) compared with perceived social support (β = −0.197). Depressive-symptom scores also differed across categories of age, family income, education, and previous PPD history. Conclusions: The study demonstrated a relatively good level of knowledge about postpartum depression among the surveyed participants. Higher perceived social support and self-efficacy were associated with better maternal mental health outcomes, highlighting their important role in the context of postpartum depression. These findings underscore the relevance of knowledge, social support, and self-efficacy in understanding postpartum mental health among the study population. Full article

Background: Patients with end-stage kidney disease commonly develop hyperparathyroidism, which may impair muscle strength and physical function. Elevated parathyroid hormone (PTH) levels have been associated with weakness and poor Timed Up and Go (TUG) test performance. We hypothesized that elevated PTH at kidney transplantation would correlate with worse TUG performance and poorer post-transplant outcomes. Methods: We performed a retrospective cohort study of 226 kidney transplant recipients (2015–2023) at a single transplant center with documented TUG testing and PTH levels. Patients were divided into normal PTH (≤600 pg/mL, nPTH) and high PTH (>600 pg/mL, hPTH) groups. Demographics, clinical characteristics, and transplant outcomes, including graft and patient survival, were analyzed. Results: The hPTH group (n = 16) was younger than the nPTH group (41.8 vs. 55.4 years, p < 0.001) and more likely to have English as a second language (62.5% vs. 35.6%, p = 0.032). They also had lower estimated post-transplant survival scores (29.3 vs. 52.0, p = 0.003) and higher rates of hyperphosphatemia (18.8% vs. 4.3%, p = 0.044). TUG pass rates, acute rejection, delayed graft function, and patient survival were similar between groups. However, the hPTH group demonstrated shorter mean graft survival (6.6 vs. 7.7 years, p = 0.022). On multivariable Cox regression, elevated PTH at transplantation remained independently associated with graft failure (adjusted hazard ratio 20.6, 95% CI 1.91–222). Conclusions: Elevated PTH at transplant was associated with poorer graft survival despite similar rejection rates and patient survival. Although not directly measured in this study, high PTH may reflect increased medical complexity or adherence-related challenges. Full article

This article examines how gender shapes the framing, governance and lived experience of women’s health within a national health system, and what this reveals about translating gender equality commitments into social policy practice. Using a convergent mixed-methods design, the study combines analysis of national policy documents and parliamentary debates in Portugal (2014–2024) with interviews with key actors (n = 13) and an exploratory national survey of women (n = 268). Across policy and political arenas, women’s health is widely recognised within gender equality and rights-based discourse, yet remains weakly consolidated within mainstream health governance. Reproductive framings dominate, while life-course dimensions such as menopause, women’s mental health and health literacy are under-articulated and weakly operationalised. Actor perspectives emphasise prevention, health literacy, communication and continuity of care, pointing to diffuse ownership and limited accountability. Survey respondents’ accounts both reproduce and extend dominant framings, highlighting mental health, information needs, access barriers and the importance of accessible and trustworthy health information. Reported care experiences reveal a pattern of “respect without responsiveness”, where positive interpersonal treatment coexists with organisational and communicative shortcomings. The article conceptualises this as a governance paradox of recognition without consolidation and shows how policy silences shape not only what becomes actionable within gendered health systems but also the informational conditions that support informed engagement with health and care. The findings have implications for designing life-course-oriented, communication-sensitive and accountability-anchored approaches to women’s health governance. Full article

The digital transformation of healthcare systems increasingly depends on the successful adoption and use of digital health technologies (DHTs) by healthcare users. In this context, digital health literacy (DHL) has emerged as a key factor influencing the effective use of digital health applications. Despite growing interest in DHL, limited research has focused on identifying distinct user profiles in the context of digital health applications. This study aims to identify DHL profiles among users of digital health applications in the Slovenian healthcare system. Data were collected from 247 respondents using the eHealth Literacy and Use Scale (eHLUS), which captures three dimensions: Autonomous Use and Technical Access, Digital Health Engagement, and DHL. Hierarchical cluster analysis (Ward’s method, Euclidean distance) was applied to identify user groups. The analysis revealed four distinct DHL profiles: Digitally Empowered Users, Digitally Vulnerable Users, Passive Digital Users, and Motivated Developing Users. The findings indicate substantial heterogeneity among users in their use of digital health applications across the dimensions of DHL. This study represents one of the first applications of the eHLUS instrument outside its original context and contributes to a better understanding of user diversity within digital healthcare systems. The findings offer a foundation for the development of targeted educational interventions, the reduction in digital inequalities, and the design of user-centered digital health applications that support the ongoing digital transformation of healthcare systems. Full article

Gestational hypertension (GH) imposes physiological and psychosocial burdens that reduce maternal well-being. Health literacy (HL) and health-related quality of life (HRQoL) are important factors influencing self-care and perceived health. This study compared HL and HRQoL between pregnant women with and without GH during the second and third trimesters of pregnancy and examined the relationship between them. A prospective longitudinal comparative study was conducted involving 378 pregnant women. HL and HRQoL were assessed during the second and third trimesters using the 12-item Health Literacy Scale (HLS-12) and the 36-Item Short Form Health Survey (SF-36), respectively. Women with GH had lower median HRQoL and HL scores in the second and third trimesters (p < 0.05). Within the GH group, HRQoL declined from 80 (65–90) to 55 (40–65) in the physical functioning domain, with similar reductions in role limitation and general health domains. The percentage of women with low or moderate HRQoL increased markedly in the GH group (p < 0.001). HL differed significantly between groups; women with GH were more frequently classified as having inadequate or problematic HL (p < 0.001). Compared to normotensive women, pregnant women with GH have lower HL and HRQoL during the second and third trimesters. The two variables were moderately correlated. There is a further need to assess HL and HRQoL in women with high-risk pregnancies and to implement effective strategies to improve the affected domains. Full article

Background/Objectives: Conflict-driven displacement can disrupt food environments, health services, and caregiver practices, increasing the risk of unhealthy feeding behaviors among young children. Evidence from ethnic internally displaced populations (IDPs) in Myanmar remains scarce. This study examined the prevalence and determinants of unhealthy feeding practices among IDP mothers of children aged 6–23 months. Methods: A sequential explanatory mixed-method study was conducted among 617 mothers in Karen ethnic IDP camps in Myanmar. Structured interviews were used to assess mother-reported zero vegetable or fruit consumption (ZVF) and unhealthy food consumption (UFC) among children, and multivariable logistic regression identified associated factors. Subsequently, six focus group discussions explored contextual influences on feeding practices and were analyzed via thematic analysis. The findings were integrated using a joint display approach. Results: A total of 29.2% of children experienced ZVF, while 57.5% consumed unhealthy foods. Mothers who attended fewer than the recommended antenatal care (ANC) visits were more likely to report both ZVF (AOR = 1.968, 95% CI: 1.297–2.988) and UFC (AOR = 1.830, 95% CI: 1.265–2.649). Higher maternal decision-making autonomy was also associated with increased odds of ZVF (AOR = 1.757, 95% CI: 1.031–2.995) and UFC (AOR = 1.606, 95% CI: 1.040–2.481). Other associated factors included child age, household income, family structure, paternal employment, and household dietary practices. Qualitative findings identified six themes influencing feeding practices: “familiarity breeds acceptance”, “traditional beliefs and food restrictions”, “constrained local food environments”, “time constraints and convenience feeding”, “preference for sweet foods”, and “disrupted access to health and nutrition services”. Conclusions: Unhealthy feeding practices were common in this displaced population. Greater maternal decision-making autonomy was not necessarily associated with healthier feeding practices, highlighting the importance of nutrition literacy and supportive food environments. Community-based nutrition interventions may help improve complementary feeding practices in conflict-affected settings. Full article

The expansion of wireless infrastructure has made anthropogenic non-ionizing electromagnetic fields (EMFs)—commonly described in public discourse as “electrosmog” or electromagnetic pollution—a pervasive feature of digitalized environments. This study examines how 81 pre-service science teachers in Türkiye conceptualized EMF-related sources, perceived risks, mitigation measures, and responsibility. A multi-source qualitative design combined inductive content analysis of nine open-ended questionnaire items with a document-informed deductive mapping based on authoritative EMF-exposure and risk-governance documents. The integrated framework distinguished diagnostic and risk-appraisal capacity, receiver–pathway–source intervention levels, governance and collective capacity, and responsibility attribution. Within a questionnaire primarily oriented toward awareness and daily-life action, responses concentrated strongly on receiver-level behavioral adaptation and attributed responsibility mainly to individuals and households. Source-level controls, monitoring, compliance, institutional responsibility, and evidence-based risk communication were not spontaneously articulated. Because these dimensions were not directly prompted, the findings do not establish a governance-literacy deficit; they define the boundaries of the mitigation repertoire elicited and generate a hypothesis for future research using explicit institutional and governance-oriented prompts. The study’s contribution lies in applying an integrated exposure-management and responsibility-attribution framework to an understudied teacher-education population and identifying curriculum needs concerning evidence appraisal, multilevel responsibility, and uncertainty-sensitive risk communication. Full article

The incidence of neoplastic disorders worldwide has steadily increased, and Romania is no exception, showing a substantial rise in active oncologic surveillance cases. Family physicians are essential to the multidisciplinary team, providing screening, early diagnosis, care during and after cancer treatment, comorbidity management, and palliative care. Primary prevention through lifestyle behavioral changes and early detection in the asymptomatic phase remain the most effective strategies to reduce cancer morbidity and mortality. However, structural barriers within the Romanian primary healthcare system, specifically fragmented digital infrastructure, administrative workloads and limited patient health literacy, frequently restrict these preventive activities. The aim of this narrative review is to analyze cancer prevention and management within Romania’s current demographic and socio-economic context, comparing the national system to models from the UK, the Netherlands, and Spain. The analysis highlights operational gaps, including low breast, cervical, and colorectal screening uptake in Romania. We concluded that optimizing patient care requires transitioning to an integrated pathway, supported by practical reforms like digital fast-track scheduling modules managed directly by family physicians. Full article

Background/Objectives: Antenatal depressive symptoms are common but frequently under-recognized. Although mental health literacy may support symptom recognition and help-seeking, its relationship with antenatal depressive symptoms remains unclear. This study examined the association between overall mental health literacy and antenatal depressive symptoms among women in the second and third trimesters of pregnancy. Methods: This cross-sectional correlational study included 568 pregnant women consecutively recruited from a university hospital’s obstetrics and gynecology outpatient clinics. The Edinburgh Postnatal Depression Scale (EPDS) and Mental Health Literacy Scale (MHLS) were administered. Spearman correlation and multivariable linear and logistic regression were used; multiple imputation handled missing covariates. Results: The mean EPDS score was 8.92 ± 5.68, and 41.9% (n = 238) screened positive for elevated depressive symptoms at the EPDS ≥ 10 threshold. A one-standard-deviation increase in the MHLS total score was associated with neither EPDS total scores (B = 0.011, 95% CI: −0.451 to 0.473, p = 0.963) nor EPDS ≥ 10 screening positivity (aOR = 1.093, 95% CI: 0.911 to 1.312, p = 0.337). Unplanned pregnancy (aOR = 1.975, p = 0.001) and third-trimester status (aOR = 1.774, p = 0.014) were associated with higher odds of screening positivity. In exploratory joint analyses, knowledge-oriented literacy was positively and resource-oriented literacy negatively associated with EPDS scores; both remained significant after Holm correction. The resource-oriented association was no longer significant when examined separately. Conclusions: Overall mental health literacy was not associated with antenatal depressive symptom severity or screening positivity. Opposing, model-dependent subscale findings require replication. These findings support assessing depressive symptoms independently of mental health literacy scores and considering pregnancy planning and gestational stage during antenatal psychosocial assessment. Full article

Background/Objectives: The menopausal transition is a period of increasing cardiometabolic risk and a window for prevention, yet preparation is often delayed until symptoms appear. Latvia has a high cardiovascular mortality burden, but population-specific menopause-awareness data are limited. This study aimed to describe item-level awareness among women aged 18–49 years in Latvia, compare age groups, and explore associated factors. Methods: An exploratory, anonymous, cross-sectional online convenience survey included 431 women aged 18–49 years in Latvia recruited through paid social media posts. An investigator-designed 47-item Latvian questionnaire was used. Primary outcomes were item-level responses to menopause-awareness Likert statements, summarized using medians, interquartile ranges, and dichotomized evidence-aligned proportions. A study-specific 10-item composite awareness score was constructed post hoc as a secondary hypothesis-generating measure. Analyses used chi-square tests, nonparametric tests, and exploratory multivariable linear regression. Results: Recognition of hot flushes (93.0%), that symptoms may appear before age 50 (91.6%), and vaginal dryness (79.8%) was high, whereas awareness that menopause may increase cardiovascular risk was limited (50.3%). Nine out of ten items showed no significant age-group difference; one reverse-keyed memory item showed a small nominal association. Composite awareness scores did not differ by age group, education level, or gynaecologist visit frequency. Internal consistency was modest (Cronbach’s α = 0.688), and the regression model explained limited variance (R² = 0.083; adjusted R² = 0.052). Previous information-seeking (B = 1.85, 95% CI 0.79–2.95, p < 0.001) and underweight BMI (B = −5.91, 95% CI −8.96 to −2.85, p < 0.001; n = 12) were independently associated with the composite awareness score. Overall, 72.6% considered educating younger women important. Conclusions: In this exploratory convenience sample, strong symptom recognition coexisted with limited cardiovascular-risk awareness, supporting earlier menopause education in Latvia that integrates cardiometabolic prevention. Full article

Farming families are central to the agricultural industry in Ireland. The poor mental health of farmers is well documented. However, the mental health of farm family members remains overlooked. This study aims to understand the mental health literacy and help-seeking of farm family members and how mental health literacy and help-seeking are associated with demographics. A cross-sectional study examined 447 farming family members’ mental health literacy and help-seeking using the Attitudes Towards Seeking Professional Psychological Help Short Form (ATSPPH-SF), Mental Help-Seeking Intention Scale (MHSIS), and the Multicomponent Mental Health Literacy Measure (MMHL). Participants reported an average ATSPPH-SF score of 20.4 ± 5.8. The average MHSIS score was 4.8 ± 1.6, and the average MMHL score was 19.4 ± 4.5. Farm family members’ mental health literacy and help-seeking attitudes and intentions were positively associated. Those who worked on the farm regularly, men, and those who were less educated had significantly lower literacy and help-seeking. The mental health literacy and help-seeking attitudes and intentions of farm family members were marginally higher than those of Irish farmers and other populations. Interventions targeting the enhancement of family members’ mental health literacy and help-seeking could support improved mental health literacy and help-seeking amongst farmers and farm family members. Full article

Background: Health literacy is widely recognized as a fundamental determinant of chronic disease self-management. Despite the escalating burden of diabetes mellitus in Saudi Arabia, the relationship between health literacy and diabetes self-care management within specific urban–peripheral communities remains inadequately characterized. This study aimed to examine the relationship between health literacy and diabetes self-care management among adults with diabetes residing in southern Riyadh, and to examine associations with key sociodemographic variables, including age, income, gender, and educational attainment. Methods: A non-experimental, cross-sectional, correlational design was employed. A purposive sample of 92 adults with a confirmed diagnosis of diabetes was recruited from primary healthcare centers in southern Riyadh. Data were gathered using the Arabic-validated 12-item European Health Literacy Scale (HLS-Q12) and the 8-item Arabic Summary of Diabetes Self-Care Activities (SDSCA). Descriptive statistics and Spearman rank-order correlations were computed using IBM SPSS Statistics, Version 25. Results: A significant positive correlation was identified between health literacy and diabetes self-care management (rs = 0.64, 95% CI [0.50, 0.75], p < 0.01). Income level demonstrated significant positive associations with both health literacy (rs = 0.41, p < 0.01) and self-care practices (rs = 0.40, p < 0.01). Age exhibited significant negative correlations with health literacy (rs = −0.36, p < 0.01) and self-care management (rs = −0.49, p < 0.01). Educational attainment was significantly associated with both self-care management (rs = 0.29, p < 0.01) and health literacy (rs = 0.26, p < 0.05). Gender was not significantly associated with either outcome. Conclusions: Health literacy was significantly associated with diabetes self-care management in southern Riyadh and may represent a potentially modifiable target for nursing intervention. Findings point to the urgency of designing equity-sensitive, culturally responsive interventions targeting older adults and economically marginalized populations. These preliminary findings may carry implications for nursing practice, diabetes education, and health policy in Saudi Arabia, pending confirmation in larger, prospective samples. Full article