Search Results (546)

Background: Vaccination is a crucial public health measure to control infectious diseases, including seasonal influenza. Yet, vaccine uptake varies globally due to sociodemographic factors, misinformation, and access disparities. Objectives: The objective of this study was to assess the prevalence and sociodemographic factors associated with vaccination and the main reasons for vaccine hesitancy in Albania. Methods: A cross-sectional study, conducted in Albania in November–December 2021, included a sample of 1302 individuals aged ≥18 years (≈57% females; mean age: 38.3 ± 15.0 years; response rate: ≈87%). A structured questionnaire was administered inquiring about co-vaccination status against seasonal influenza and COVID-19, reasons for not being vaccinated, and sociodemographic characteristics of participants. Binary logistic regression was used to assess the association of co-vaccination status with sociodemographic factors. Results: Overall, about 28% of individuals were co-vaccinated against seasonal influenza and COVID-19 at least with one dose (25% in males vs. 29% in females; 22% among 18–24-year-olds vs. 54% among those aged ≥65 years). Independent positive and significant correlates of being co-vaccinated included older age (OR = 7.0, 95%CI = 3.7–12.9) and a higher educational attainment (OR = 2.3, 95%CI = 1.4–3.6). The main reasons for vaccine hesitancy among non-vaccinated individuals included the belief that vaccines are: harmful (72%), not effective (66%), weaken the immune system (58%), are not safe (56%), and preference to recover naturally (52%). Conclusions: This study evidenced a relatively low co-vaccination rate in Albania with significant sociodemographic disparities, notwithstanding the availability of vaccines and their free-of-charge provision to the overall population. Older age and higher educational attainment were identified as independent positive predictors of co-vaccination uptake, suggesting the need for targeted public health strategies to address vaccine hesitancy, particularly among younger and less-educated population categories. Our findings emphasize the importance of tailored communication campaigns and community-based interventions to improve vaccine coverage and mitigate the impact of infectious diseases in Albania and elsewhere. Full article

Background/Objectives: Official data on the oral health of young children in Romania are limited, especially concerning the societal shifts following the COVID-19 pandemic. This study aimed to compare the oral health status, hygiene habits, diet, and dental care patterns of 6-year-old children in a rural Romanian region before and after the pandemic. Methods: A cross-sectional survey studied two groups of 6-year-olds from rural Transylvania: Group 1 (n = 77), assessed 2018–2020 pre-pandemic, and Group 2 (n = 136), assessed in 2024 post-pandemic. Clinical data used the Decayed, Missing, and Filled Teeth (DMFT) index. Parents completed questionnaires on oral hygiene, diet, dental visits, and pandemic-related topics for Group 2. Chi-square, Student’s t-tests, and a multiple linear regression were used to analyze the data. Results: Post-pandemic, 70% of children brushed twice daily, up from 26%. Despite this, negative outcomes increased: the number of affected teeth rose from 6.8% to 29.6% (p < 0.001), sugar intake increased, and dental visits became more reactive, with pain being the main reason for 61% of post-pandemic visits, compared to 17% pre-pandemic. Conclusions: This study reveals a significant oral health paradox: despite a three-fold increase in recommended toothbrushing, caries experience in permanent teeth increased four-fold. This outcome was driven by a high-risk environment of more cariogenic diets and reduced preventive care, with lower maternal education also identified as a key independent risk factor. These findings show that promoting hygiene alone is insufficient, underscoring the urgent need for public health programs that integrate nutritional counseling, improve access to preventive care, and address underlying socioeconomic disparities. Full article

Background: Hearing impairment is a significant public health issue globally, yet national data for Saudi Arabia remain sparse. Methods: Using data from the 2017 Disability Survey, we analysed 12 hearing-related indicators across 13 administrative regions. Descriptive statistics, logistic regression, cluster analysis, and residual mapping were applied to identify socio-demographic disparities and service gaps. Findings: Among 20,408,362 Saudi nationals, about 1,445,723 (7.1%) reported at least one functional difficulty. Of these, 289,355 individuals (1.4%) had hearing impairment, either alone or with other difficulties—229,541 (1.1%) had hearing impairment combined with other disabilities, while 59,814 (0.3%) had only hearing impairment. Females and males were equally affected. Notably, educational attainment and marital status significantly influenced device uptake; less-educated and divorced individuals were particularly underserved. Regionally, southern provinces (Al-Baha, Jazan, and Najran) demonstrated the highest unmet need due to geographic barriers, limited audiological resources, and socioeconomic constraints, reflecting compounded risks from consanguinity and rural isolation. Cluster analyses identified provinces requiring urgent attention, recommending mobile audiology units, tele-audiology services, and means-tested vouchers to enhance coverage. Conclusions: Despite Saudi Arabia’s existing public audiology services and a National Newborn Hearing Screening programme achieving 96% coverage, substantial gaps remain in follow-up care and specialist distribution, underscoring the necessity for systematic workforce tracking and enhanced rural incentives. International evidence from India and Brazil underscores the feasibility and cost-effectiveness (approximately USD 5200/QALY) of these recommended interventions. Implementing targeted provincial strategies, integrating audiological screening into routine healthcare visits, and aligning resource allocation with the WHO and Vision 2030 benchmarks will significantly mitigate hearing impairment’s health, social, and economic impacts, enhancing the quality of life and societal inclusion for affected individuals. Full article

(1) Background: Socioeconomic conditions and environmental exposures are well-established determinants of health and aging, yet the pathways through which they influence the aging process remain insufficiently understood. Clarifying these mechanisms is critical for developing effective, equity-focused public health interventions to support healthy aging; (2) Methods: We conducted a narrative review examining the relationships between socioeconomic conditions, environmental exposures, and aging-related health outcomes. While the scope was intentionally broad to capture diverse exposures and outcomes, we applied a systematic search strategy to identify relevant peer-reviewed studies; (3) Results: The search populated over 4000 articles; 33 relevant papers were selected. The evidence suggests that environmental exposures may mediate or modify the effects of socioeconomic disadvantage on aging. Conversely, socioeconomic conditions can alter the association between environmental factors and aging outcomes. Disadvantaged populations consistently face higher environmental burdens and exhibit poorer aging outcomes, including accelerated biological aging and increased risk of age-related disease; (4) Conclusions: The complex interplay between social and environmental factors contributes to disparities in aging. Our integrative approach highlights the need for more intersectional, longitudinal research to inform interventions that address the social and environmental determinants of healthy aging. Full article

Blood-based biomarkers allow monitoring of an individual’s health status and provide insights into metabolic and inflammatory processes in conditions like obesity, cardiovascular, and liver diseases. However, selecting suitable biomarkers and optimizing analytical assays presents challenges, is time-consuming and laborious. Moreover, knowledge of potential sex differences remains incomplete as research is often carried out in men. This study aims at enabling researchers to make informed choices on the type of biomarkers, analytical assays, and dilutions being used. More specifically, we analyzed plasma concentrations of >90 biomarkers using commonly available ELISA or electrochemiluminescence-based multiplex methods, comparing normal weight (BMI < 25; n = 40) with obese (BMI > 30; n = 40) adult blood donors of comparable age. To help choose optimal biomarker sets, we grouped frequently employed biomarkers into biological categories (e.g., adipokines, acute-phase proteins, complement factors, cytokines, myokines, iron metabolism, vascular inflammation), first comparing normal-weight with obese persons, and thereafter exploratively comparing women and men within each BMI group. Many biomarkers linked to chronic inflammation and dysmetabolism were elevated in persons with obesity, including several adipokines, interleukins, chemokines, acute-phase proteins, complement factors, and oxidized LDL. Further exploration suggests sex disparities in biomarker levels within both normal-weight and obese groups. This comprehensive dataset of biomarkers across diverse biological domains constitutes a reference resource that may provide valuable guidance for researchers in selecting appropriate biomarkers and analytical assays for own studies. Moreover, the dataset highlights the importance of taking possible sex differences into account. Full article

Extreme heat poses growing health risks in tropical regions, yet public perception of this threat remains understudied in the Caribbean. This study examines how residents in Puerto Rico perceived heat-related health risks and how these perceptions relate to vulnerability and protective behaviors during the extreme heat events of the summer of 2020. We conducted a cross-sectional telephone survey of 500 adults across metropolitan and non-metropolitan areas of Puerto Rico, using stratified probability sampling. The questionnaire assessed heat risk perception, sociodemographic characteristics, health status, prior heat exposure, and heat-related behaviors. While most participants expressed concern about climate change and high temperatures, fewer than half perceived heat as a high level of personal health risk. Higher levels of risk perception were significantly associated with being male, aged 50–64, unemployed, and in fair health, having multiple chronic conditions, and prior experience with heat-related symptoms. Those with symptoms were nearly five times more likely to report high levels of risk perception (OR = 4.94, 95% CI: 2.93–8.34). In contrast, older adults (65+), despite their higher level of vulnerability, reported lower levels of risk perception and fewer symptoms. Nighttime heat exposure was widespread and strongly associated with heat-related symptoms. Common coping strategies included the use of fans and air conditioning, though economic constraints and infrastructure instability limited access. The findings highlight the disparity between actual and perceived vulnerability, particularly among older adults. Public health strategies should focus on risk communication tailored to vulnerable groups and address barriers to heat adaptation. Strengthening heat resilience in Puerto Rico requires improved infrastructure, equitable access to cooling, and targeted outreach. Full article

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder with significant racial and ethnic disparities in prevalence, disease severity, and outcomes. Cardiovascular complications, including pericarditis, myocarditis, valvular disease, and conduction abnormalities, contribute to increased morbidity and mortality in SLE patients. This study examines racial and ethnic disparities in cardiovascular outcomes among hospitalized SLE patients in the United States. Methods: This retrospective study utilized the National Inpatient Sample (NIS) database from 2016 to 2021 to analyze hospitalizations of adult patients (≥18 years) with a primary or secondary diagnosis of SLE. Patients were stratified into racial/ethnic groups: White, Black, Hispanic, Asian, Native American, and Other. Primary outcomes include major adverse cardiovascular events (MACEs), which are a composite of in-hospital mortality, myocardial infarction (MI), sudden cardiac death, and other SLE-related outcomes including cardiac, pulmonary, and renal involvement. Statistical analyses included multivariable logistic regression models adjusted for demographic, socioeconomic, and hospital-related factors to assess racial disparities. Results: The study included 514,750 White, 321,395 Black, and 146,600 Hispanic patients, with smaller proportions of Asian, Native American, and Other racial groups. Black patients had significantly higher odds of in-hospital mortality (OR = 1.17, 95% CI = 1.08–1.26, p < 0.001) and sudden cardiac death (OR = 1.64, 95% CI = 1.46–1.85, p < 0.001) compared to White patients. Asian patients also exhibited increased mortality risk (OR = 1.37, 95% CI = 1.14–1.63, p = 0.001) as compared to Whites. Conversely, Black (OR = 0.90, 95% CI = 0.85–0.96, p = 0.01) and Hispanic (OR = 0.87, 95% CI = 0.80–0.96, p = 0.03) patients had lower odds of MI. Racial disparities in access to care, socioeconomic status, and comorbidity burden may contribute to these differences. Conclusion: Significant racial and ethnic disparities exist in cardiovascular outcomes among hospitalized SLE patients. Black and Asian individuals face higher in-hospital all-causes mortality and sudden cardiac death risks, while Black and Hispanic patients exhibit lower MI rates. Addressing social determinants of health, improving access to specialized care, and implementing targeted interventions may reduce disparities and improve outcomes in minority populations with SLE. Full article

Background: Prematurity and low birth weight (LBW) drive infant morbidity and mortality, requiring nutritional interventions, especially in food-insecure settings. In Indonesia, regional disparities in food security hinder adequate nutrition for premature and LBW infants, exacerbating health challenges. The aim of study is to investigate and determine factors associated with prematurity and LBW in children from food-insecure and food-secure households. Methods: This research employed a cross-sectional study with 657 mothers of children aged 36–59 months, conducted using random sampling. Data was collected via standardized questionnaires and analyzed using Chi-square tests and logistic regression. Results: The adjusted model showed that children of food-insecure households had a higher risk of LBW (AOR = 0.54; 95% CI: 0.29–0.99; p < 0.05). LBWs were found to significantly less occur in food-insecure households. Low maternal education was associated with an increased risk of preterm birth (AOR = 3.23; 95% CI:1.78–5.84; p < 0.001). Furthermore, prematurity correlated with house ownership (p < 0.01), indicating the household’s wealth condition. Maternal education and house ownership were linked to prematurity, indicating the risk to child health outcomes. In summary, maternal education, employment status, and household income were linked to food insecurity, indicating the risk to child health outcomes. Conclusion: Strategies to improve child health outcomes are essential, including enhancing maternal nutrition knowledge to improve child feeding practices, promoting gender equality in career development, and reducing food insecurity in households. Full article

Society’s adaptation to shared mobility services is a growing topic that requires detailed understanding of the local circumstances of potential and current users. This paper focuses on analyzing barriers to the adoption of urban bike-sharing systems in post-industrial cities, using a case study of the Silesian agglomeration in Poland. Methodologically, the article integrates quantitative survey methods with multivariate statistical analysis to analyze the demographic, socioeconomic, and motivational factors that underline the adoption of shared micromobility. The study highlights a detailed segmentation of users by income, age, professional status, and gender, as well as the observation of profound disparities in access and perceived usefulness. Of note is the study’s identification of a highly concentrated segment of young, low-income users (mostly students), which largely accounts for the general perception of economic and infrastructural barriers. These include the use of factor analysis and regression to plot the interaction patterns between individual user characteristics and certain system-level constraints, such as cost, infrastructure coverage, weather, and health. The study’s findings prioritize problem-specific interventions in urban mobility planning: bridging equity gaps between user groups. This research contributes to the current literature by providing detailed insights into the heterogeneity of user mobility behavior, offering evidence-based recommendations for inclusive and adaptive options for shared transportation infrastructure in a changing urban context. Full article

Introduction: Dental caries and molar–incisor hypomineralisation (MIH) are prevalent conditions affecting children’s oral health, with functional, aesthetic, and psychosocial implications. In Spain, previous studies have highlighted geographic and sociodemographic disparities in their distribution, particularly among rural and migrant populations. Objective: To characterise oral health status, in terms of caries and MIH, among 6–7-year-old children from the towns of Palos de la Frontera, Mazagón, and San Bartolomé. Methods: A cross-sectional study was conducted involving 229 children recruited from public primary schools. Sociodemographic, anthropometric, and behavioural data were collected through clinical examination and interview. Statistical analysis included univariate and multivariate logistic regression. The study protocol was approved by the Ethics Committee of Huelva. Results: The prevalence of caries (DMFT ≥ 1) was 53.3%, with mean DMFT and dft indices of 1.78 and 0.31, respectively. MIH affected 32.8% of the cohort, with a predominance in the first permanent molars (teeth 36 and 26). Multivariate analysis identified independent predictors of caries: African (OR = 7.47; 95% CI: 2.84–23.8) and European (OR = 4.56; 95% CI: 1.26–22.3) parental origin, poor oral hygiene (OR = 3.07; 95% CI: 1.60–6.03), and the presence of MIH (OR = 3.20; 95% CI: 1.64–6.42). The municipality of San Bartolomé was associated with a higher risk of MIH (OR = 2.90; 95% CI: 1.21–7.45). Conclusions: The high prevalence of caries and MIH in the Condado-Campiña district, exceeding national averages, reflects oral health inequities linked to social determinants (migrant origin, locality) and clinical factors (MIH, oral hygiene). Targeted preventive interventions are urgently needed in high-risk populations, including culturally tailored education and policies ensuring equitable access to dental care services. Full article

Differences exist between rural–urban migrants and urban–urban migrants in terms of human capital’s accumulation and pathways of social integration, yet few studies have systematically compared these distinctions. Based on the CMDS2017 survey data, this study constructed a comprehensive social integration index across four dimensions—economic integration, behavioral adaptation, identity recognition, and psychological assimilation—to analyze the influencing factors and decompose the disparities in social integration levels between the two groups from a human capital perspective. Using Oaxaca mean decomposition and Machado–Mata (MM) quantile decomposition, the results indicated that urban–urban migrants exhibited higher social integration levels than rural–urban migrants, with human capital significantly influencing integration outcomes. Better education, health status, longer migration duration, and more work experience positively enhanced migrants’ social integration. Human capital accounted for 38.35% of the social integration gap between the two groups, while coefficient differences were the primary driver of disparities. The returns to education diminish at higher integration levels, suggesting education played a stronger role for those with lower integration. The social integration gap between the two groups followed an inverted U-shaped trend, with smaller disparities at higher quantiles. As integration levels rose, characteristic differences declined continuously, indicating convergence toward homogeneity among high-integration migrants. These research findings indicated that the improvement in the social integration level of migrants still requires continuous investment in cultivating the human capital of migrants. Full article

Health literacy is a critical determinant of health outcomes, yet it is often overlooked, particularly among marginalized groups. This paper explores the significance of health literacy, with a particular focus on low-income African American and Black (AA/B) men, a population that faces unique challenges due to intersecting factors such as race, gender, socioeconomic status, and educational disparities. We examine how these factors contribute to health literacy gaps, highlighting adverse effects on health outcomes for AA/B men compared to the general population. Additionally, we stress the growing importance of digital literacy in an increasingly technology-driven world. Not actively addressing digital health literacy, especially within chronic disease self-management programs (CDSMPs), further exacerbates health disparities within this group. Recommendations are provided for improving health literacy, with specific strategies to also enhance general literacy and digital literacy, among low-income AA/B men. The paper also advocates for a systematic review of the existing literature on health literacy among this group, emphasizing the need for tailored interventions that account for the unique challenges faced by low-income AA/B men. In conclusion, the paper underscores the critical need for targeted research and practical approaches to improve health literacy and ultimately health outcomes for AA/B men in the digital age, particularly through CDSMPs. Full article

Background/Objectives: The prognostic uncertainty of Mild Cognitive Impairment (MCI) imposes comprehensive neuropsychological evaluations beyond mere memory assessment. However, previous investigations into other cognitive domains, such as attention, have yielded divergent findings. Furthermore, while evidence suggests the presence of sex differences across the spectrum of dementia-related conditions, no study has systematically explored attentional disparities between genders within this context. The current study aims to investigate differences in the attentional subcomponents, i.e., alerting, orienting, and executive control, between patients with MCI and healthy older controls (HOCs), emphasizing interactions between biological sex and cognitive impairment. Methods: Thirty-six participants (18 MCI, and 18 HOCs) were evaluated using the Attention Network Test (ANT). Raw RTs as well as RTs corrected for general slowing were analyzed using Generalized Mixed Models. Results: Both health status and sex influenced ANT performance, when considering raw RTs. Nevertheless, after adjusting for the baseline processing speed, the effect of cognitive impairment was no longer evident in men, while it persisted in women, suggesting specific vulnerabilities in females not attributable to general slowing nor to the MCI diagnosis. Moreover, women appeared significantly slower and less accurate when dealing with conflicting information. Orienting and alerting did not differ between groups. Conclusions: To the best of our knowledge, this is the first study investigating sex differences in attentional subcomponents in the aging population. Our results suggest that previously reported inconsistencies about the decline of attentional subcomponents may be attributable to such diversities. Systematically addressing sex differences in cognitive decline appears pivotal for informing the development of precision medicine approaches. Full article

Background/Objectives: The use of artificial sweeteners (AS) is increasing globally despite growing evidence suggesting potential health risks. This study investigates the sociodemographic and health-related factors associated with AS use in the Hungarian population. Methods: We conducted a cross-sectional analysis using data from the 2019 European Health Interview Survey (EHIS), comprising 5603 participants. AS users were identified based on self-reported use of AS. Logistic regression models were used to examine associations between regular AS use and demographic, socioeconomic, and health variables. Interaction terms were included to explore potential effect modification. Results: AS use was reported by 20.1% of participants. Older adults, individuals with overweight or obesity, and those reporting poorer self-perceived health were more likely to use AS. AS use was also higher among individuals in lower and middle-income quintiles. Interaction analyses revealed that overweight and obese individuals with the lowest income, as well as older adults in poor health, were particularly likely to use AS. Conclusions: The findings highlight disparities in AS use across age, income, BMI, and health status, raising concerns about the public’s perception of AS as a healthier alternative. Public health strategies should focus on increasing awareness of the potential risks and encourage evidence-based dietary choices. Full article

This article focuses on how rising nativism, manifested through immigrants’ experiences of everyday discrimination, and Florida’s legal context (ascertained through immigrants’ fears of deportation), are related to immigrants’ hesitation when seeking healthcare services. Hesitation to seek healthcare, or healthcare hesitancy, is examined in the context of Florida’s SB1718, a law passed in 2023 that criminalized many aspects of being an immigrant. Based on a survey of 466 Florida immigrants and U.S. citizen adult children of immigrants, logistic regression analysis reveals that everyday experiences with discrimination are associated with a reluctance to seek healthcare services among this population. In particular, those with insecure legal immigrant status (i.e., undocumented and temporary statuses), those with financial hardship, and women demonstrate reluctance to engage with healthcare systems when controlling for other sociodemographic factors. Findings from this study exemplify how immigration policies that restrict access to healthcare and social services not only create logistical barriers to seeking care but also foster a climate of fear and exclusion that deters even those with legal status from seeking medical attention. Full article