Search Results (7,197)

Background/Objectives: Knowledge of plant-based diets is gaining increasing significance in adolescents due to the growing popularity of vegetarian and vegan dietary patterns. To date, there has been limited research examining the level of awareness and understanding of these diets among secondary school students, as well as the factors influencing their knowledge. The aim of the study was to determine the prevalence of plant-based diets and to assess knowledge regarding these dietary patterns among high school students, as well as to identify factors associated with both diet adherence and achieving sufficient nutritional knowledge. Methods: A cross-sectional study was conducted among 341 high school students. Data were collected using a self-administered paper questionnaire that included demographic information, self-reported body weight and height, adherence to plant-based diets, and knowledge of vegetarian and vegan nutrition. Nutritional knowledge was assessed using a structured 19-item questionnaire (25 scorable items) and verified for reliability (test–retest, Krippendorff’s alpha = 0.88). Based on a 25-point scale, a score of >60% (16–25 points) was categorized as ‘sufficient’ knowledge. Statistical analyses included the chi-square test, Mann–Whitney and Kruskal–Wallis non-parametric tests, and multivariable logistic regression to estimate adjusted odds ratios (aOR) for factors associated with sufficient knowledge. Results: The prevalence of plant-based diets in the study group was 16.1% (n = 55), with a significantly higher frequency observed among female students and those with sufficient nutritional knowledge. The majority of students (81.2%) achieved sufficient knowledge. Higher scores were observed among female students, those in higher grade levels, and those individuals adhering to plant-based diets (p < 0.05). Multivariate regression analysis indicated that male sex (aOR = 0.38 compared to females), higher grade level (aOR = 3.66 for grade 3 vs. grade 1; aOR = 3.62 for grade 4 vs. grade 1), residence in a rural area (aOR = 0.50), and non-adherence to a plant-based diet (aOR = 0.32) were independently associated with sufficient knowledge. Conclusions: The majority of high school students demonstrate sufficient knowledge regarding plant-based diets, with significant variations associated with sex, grade level, place of residence, and experience with plant-based diets. These findings underscore the need for targeted educational interventions, particularly among male students, those in lower grade levels, and individuals residing in rural areas. Full article

Background: Childhood obesity is a major public health concern associated with adverse metabolic outcomes later in life. Despite increased awareness, unhealthy lifestyle behaviors—including suboptimal diet quality, physical inactivity, insufficient sleep, and unfavorable body composition—remain prevalent in pediatric populations. Effective, child-centered educational tools for early prevention are still limited. Methods: We developed the Lifestyle Tridimensional Pyramid, an educational model integrating nutrition, physical activity, and sleep within a single, three-dimensional framework. The model also addresses body composition by emphasizing the balance between skeletal muscle and adipose tissue and the interdependence of lifestyle behaviors. This narrative review is supported by an umbrella review of 17 systematic reviews and meta-analyses published between 2010 and 2025, synthesizing evidence on lifestyle behaviors of pediatric obesity. Results: High- to moderate-quality evidence indicates that adherence to Mediterranean-style dietary patterns, regular moderate-to-vigorous physical activity, adequate sleep duration, and a healthier body composition might prevent the development of obesity and improved cardiometabolic profiles in children and adolescents. The pyramid provides a structured, visually accessible tool to support lifestyle counseling in pediatric outpatient settings and is adaptable to school- and community-based health promotion. Conclusions: Although prospective validation studies are warranted, the Lifestyle Tridimensional Pyramid represents a practical, evidence-informed framework to support integrated lifestyle education and improve primary and secondary prevention of pediatric obesity. Full article

This study characterizes the multifractal structure of monthly precipitation in the semi-arid state of Guanajuato, Mexico, using Multifractal Detrended Fluctuation Analysis with quadratic detrending (MFDFA-2). We analyze 65 quality-controlled meteorological stations covering the period 1981–2016. All series exhibit multifractality, with generalized Hurst exponents $h\left(2\right)=0.568\pm 0.065$ indicating predominantly persistent dynamics and long-term positive autocorrelation (64.6% of stations). The multifractal spectrum width ($\Delta \alpha$) ranges from 0.15 to 0.72 (mean = 0.2423), revealing substantial spatial variability in scaling complexity. K-means clustering based on multifractal features identifies the following four hydroclimatic groups: one random cluster (29.2% of stations) and three persistence-dominated clusters (70.8%), with coherent spatial organization. These findings provide new insights into the temporal scaling properties of precipitation in semi-arid regions and have important implications for water resource management and regionalized drought-risk assessment. Full article

Background/Objectives:Human papillomaviruses (HPVs) are the most common sexually transmitted viruses worldwide and are strongly associated with multiple cancers, including cervical cancer. In France, HPV prevention relies on a combination of organized cervical cancer screening and prophylactic vaccination; however, coverage remains below international targets. Methods: This narrative review summarizes recent advances in HPV prevention in France, with a focus on screening strategies, including the integration of high-risk HPV testing and vaginal self-sampling, as well as vaccination policies that now include both girls and boys, notably through school-based programs. Results: International comparisons, particularly with Australia and several European countries, are used to highlight successful strategies and transferable lessons that could enhance the effectiveness of French prevention efforts. The review also discusses persistent barriers to uptake, including social, organizational, and cultural factors, and considers opportunities to reduce inequalities in access to prevention. Conclusions: Overall, this work provides a comprehensive overview of the current landscape of HPV prevention in France and situates national efforts within a global public health context, offering insights for policy development and future research directions. Full article

This study aims to examine the improvement of algebra problem-solving ability and metacognitive awareness among junior high school students through the use of visualization based on a deep learning approach. The research employed a quantitative method with a quasi-experimental design, specifically a pretest–posttest control group design. The population consisted of all students from public schools in Tangerang City, Indonesia. The sample comprised seventh-grade students studying algebra. A purposive sampling technique was used to determine the experimental and control groups, with a total sample size of 51 students. The instruments included an algebra problem-solving ability test consisting of nine essay questions and a metacognitive awareness questionnaire with 52 items. Data were collected using these two instruments, with a pretest administered before the intervention and a posttest administered afterward. Data analysis was conducted using a prerequisite test, continued with independent sample t-tests, nonparametric tests, ANCOVA, and multiple linear regression. The results based on statistics indicated a significant improvement in students’ algebra problem-solving ability with a large effect. Nevertheless, the absolute increase in problem-solving scores in the experimental group is very small (N-gain mean = 0.02). Additionally, metacognitive awareness was not found to be a significant predictor of problem-solving ability; instead, initial ability (pretest) emerged as the strongest predictor. Only understanding the problem has a moderate effect; planning strategies has a small effect, and otherwise there is no effect. In conclusion, the use of visualization-based worked examples with a deep learning approach has a statistically significant effect, but its impact on improving students’ abilities should be interpreted with caution. So the practical effects of the intervention are limited; however, metacognitive awareness is not the main predictor in algebra problem-solving ability. Full article

Morocco’s recent legalization of industrial and medicinal cannabis has created a rapidly expanding seed-oil sector whose sustainability has yet to be fully assessed. This study applies an environmental life cycle assessment (LCA) in accordance with ISO 14040:2006 and ISO 14044:2006, complemented by a qualitative social responsibility assessment based on ISO 26000:2010, aiming to evaluate the life cycle sustainability of Moroccan cannabis seed oil. Three representative processing chains, traditional artisanal presses, producer cooperatives and regulated industrial plants are compared using a functional unit of 1 kg of cold-pressed oil packaged for local distribution. Inventory data were drawn from field measurements and interviews and were modeled in OpenLCA with background datasets from Ecoinvent 3.8 and Agribalyse v3.1. Impact assessment used the ReCiPe 2016 (H) method at the midpoint level across nine categories (climate change, fossil resource scarcity, water use, freshwater eutrophication, terrestrial acidification, land occupation, carcinogenic, non-carcinogenic human toxicity, and fine particulate matter formation). Sensitivity analyses varied seed yield, electricity mix and transport distances by ±20% to gauge uncertainty. Results show that the cooperative scenario achieves the lowest impacts across nearly all categories because of higher extraction yields (3 kg seed per kg oil), lower energy use (0.54 kWh kg⁻¹ oil) and more effective co-product recovery. In contrast, artisanal extraction requires approximately 1 kg of additional seed input per functional unit compared to optimized scenarios, significantly increasing upstream environmental burdens and causing upstream agricultural burdens to multiply. Industrial facilities perform comparably to cooperatives if powered by renewable electricity. Integrating a semi-quantitative social responsibility assessment reveals that legalization has markedly improved organizational governance, labor conditions, consumer protection and community involvement. Cooperatives display the most balanced social performance, whereas industrial plants excel in governance and quality control. A set of recommendations, including drip irrigation, cultivar improvement, co-product valorisation, renewable energy adoption, eco-designed packaging and cooperative governance, is proposed to enhance the environmental and socio-economic sustainability of Morocco’s emerging cannabis seed-oil industry. Full article

European pork production pursues traceability and authenticity to ensure animal welfare, food safety, and support products with geographical indications. This study reports a European survey integrating stable isotope ratios (δ¹³C, δ¹⁵N, δ³⁴S, δ¹⁸O, δ²H) and multi-element profiling using IRMS and ICP-MS, on 612 samples collected across Denmark, Poland, Italy, and Spain, with diverse production systems, breeds, feeding, and slaughter ages. Geographical and climatic gradients influenced δ²H and δ¹⁸O, which ranged from −111‰ to −89‰ in samples from Denmark and Spain and from 13.3‰ to 16.0‰ in samples from Italy and Spain, respectively. In selected farms, δ¹³C ranged from −22.7‰ to −17.0‰ depending on diet composition based on C₃ and C₄ plants. The wide variability in pig management practices suggested that δ¹⁵N (2.50 ÷ 4.96‰) increased with slaughter age and was positively correlated with Fe (3.38 ÷ 8.39 mg/kg) and Zn (9.39 ÷ 23.6 mg/kg). Most mineral components were mainly driven by feed formulation and supplementation. Principal component analysis (PCA) showed that samples were grouped based on their origin and husbandry system, confirming the key role of isotopic and elemental markers for the development of a database supporting the pork supply chains across Europe. Full article

Background: Evidence shows that simulation-based education for nurses and midwives contributes to strengthening patient safety and quality of care in healthcare settings. Nevertheless, it is implemented to a limited degree in Sub-Saharan African (SSA) higher education institutions, including Tanzania. This demands that Tanzania shift from a traditional model of teaching to incorporate simulation-based education to produce a skilled workforce. Objective: To explore perceptions and experiences of nurse educators (lecturers) and midwives on simulation-based education in Tanzania. Methods: The study employed a generic qualitative descriptive study design with purposive sampling. The data were collected through individual semi-structured interview guides with nurse educators and midwives (nine nurse educators and 11 midwife graduates) from two selected universities in the School of Nursing and their respective teaching hospitals. Qualitative inductive content analysis was used to analyze the data. Results: The data analysis revealed three themes and nine sub-themes: 1. Knowledge and skills in simulation-based education. 2. Challenges in the implementation of simulation-based education. 3. Ensuring patients’ safety. Conclusions: Students were indeed experienced, but not trained in how to use simulation-based education, and nurse educators had inadequate skills. A high number of students with inadequate infrastructure and resources is the major challenge experienced by participants. Simulation-based education is at an early stage of adoption in Tanzania and will require ongoing development, support and resources to fulfilll its potential in promoting patient safety. Full article

Cronobacter sakazakii is an opportunistic pathogen commonly associated with powdered infant formula and causes severe neonatal infections. While whole-genome sequencing (WGS)-based single nucleotide polymorphism (SNP) analysis has revolutionized surveillance and outbreak investigations, comprehensive population-level analyses remain limited, and establishing proper thresholds for detecting epidemiologically related C. sakazakii isolates requires assessment using large-scale genomic datasets. We analyzed 1870 C. sakazakii genomes from the United States (1970–2025) to examine pan- and core-genomic structure, analyze SNP distance matrices encompassing 1,747,515 unique pairwise comparisons, and reconstruct population phylogeny. Our analyses revealed exceptional genomic diversity with a large pan-genome of 24,035 gene families and an average of 29,442 ± 13,097 SNPs between genome pairs. Phylogenetic reconstruction identified 22 major clusters encompassing 89.3% of genomes, including environmental complexes demonstrating persistent contamination spanning multiple years. Using 209 monophyletic genome pairs with concordant metadata, we propose a tiered SNP threshold framework (≤234 to 506 SNPs) for detecting potentially epidemiologically-related genomes with improved sensitivity. As genomes from Michigan comprised 39.3% of the dataset, these thresholds should be interpreted with caution when applied to other US regions. This study provides population genomics infrastructure to enhance C. sakazakii surveillance and traceback studies for improving powdered infant formula safety. Full article

Vocational high school students represent a substantial yet understudied population in school-based mental health research. Drawing on positive psychology and bioecological theory, this study examined whether personal growth initiative (PGI) shows a statistical indirect effect with respect to the relationships between multidimensional school climate and mental health outcomes among Chinese vocational students. Participants were 14,006 students from 112 vocational high schools. Two-level path models simultaneously entered different climate dimensions to estimate their unique associations with PGI, depressive symptoms, and Subjective well-being (SWB) at the within- and between-school levels, controlling for gender and socioeconomic status. Within schools, Safety, Interpersonal Relationships, Rules and Norms/Career Development Support, and Teaching and Learning/Diversity were positively associated with PGI, which in turn was associated with lower depressive symptoms and higher SWB. Wald tests indicated that Safety showed the strongest overall association with depressive symptoms, whereas Interpersonal Relationships showed the strongest overall association with SWB. At the between-school level, school-average climate and school-average PGI were associated with both outcomes, although these findings should be interpreted cautiously given the limited between-school power and substantial overlap among aggregated climate indicators. Overall, the findings are consistent with PGI being an important student-level pathway linking school climate to mental health in vocational education. Full article

The Individuals with Disabilities Education Act (IDEA) provides special education services to students with disabilities, including autistic students, until age 21. However, the ages at which autistic students exit high school—and the reasons for exit—are not well documented, despite their importance for transition planning. We analyzed U.S. Department of Education Section 618 Part B data for special education students ages 14–21 across five school years (2014–2015 to 2018–2019) to examine exit age and exit category, with comparisons among autistic students, students with intellectual disabilities (IDs), and students with other disabilities. Using publicly reported counts of students exiting at each age, we derived mean exit ages by transforming age-specific count data. In 2019, 71% of autistic students graduated with a diploma, compared with 48% of students with IDs and 72.5% of students with other disabilities. Autistic students had lower dropout rates (6–8%) than students with other disabilities (15–18%). The mean exit age for autistic students was approximately 18 years, with an average graduation age of 17.9 years, indicating that many students exited prior to the end of extended IDEA eligibility in their state. These findings provide descriptive context on when autistic students exit high school relative to IDEA eligibility and underscore the importance of transition planning and coordination with adult service systems, though these factors were not directly examined in the present analysis. Full article

Objectives: Oral health-related quality of life (OHRQoL) reflects the functional and psychosocial impacts of oral conditions on daily life. In low-resource settings such as rural Tanzania, limited access to dental care and preventive services may increase the burden of oral disease. This study assessed the association between clinical oral health conditions and OHRQoL among schoolchildren in rural Tanzania. Methods: A cross-sectional study was conducted among 293 schoolchildren at Igelehezda Primary School, Ilembula, Tanzania. Clinical examinations assessed dental caries using the DMFT index and oral hygiene using the OHI-S index. OHRQoL was measured with the Child Oral Impact on Daily Performances (C-OIDP) questionnaire. Behavioral data included sugar intake, number of daily meals, and toothbrushing-related symptoms. Associations between clinical, behavioral factors and OHRQoL were analyzed using descriptive statistics, bivariate tests, and multiple linear regression (p < 0.05). Results: All 293 children completed the study (mean age 12.2 ± 1.2 years; 157 females, 136 males). Mean DMFT was 2.7 ± 4.1, with 80.5% free of untreated caries, and mean OHI-S indicated good oral hygiene (0.4 ± 0.6). Most participants were periodontally healthy (68.3%). Toothache, gum pain, or bleeding during brushing were reported by 26.0–31.6%. Eating was the most affected daily activity (42.7%). Missing teeth, toothbrushing-related symptoms, and consumption of high-sugar sweets were significantly associated with higher C-OIDP scores (p < 0.05), while a higher number of daily meals was associated with fewer impacts. Conclusions: Missing teeth, toothbrushing-related symptoms, and high sugar intake were associated with greater impairment in daily life, particularly affecting eating. These findings highlight the need for preventive and educational oral health interventions in rural, resource-limited settings. Full article

This study examines the design and pedagogical evaluation of Extended Reality (XR) applications, with a primary focus on location-based Augmented Reality (AR). The XR applications were implemented within an environmental education program delivered by the Education Center for the Environment and Sustainability (E.S.E.C.) of Kastoria, aiming to enhance students’ understanding of lake ecosystems and environmental awareness through immersive, situated learning experiences. The development followed the ADDIE instructional design framework and was grounded in principles of experiential and situated learning. The educational intervention was conducted in an authentic field setting along the shoreline of Lake Kastoria and combined location-based AR activities with complementary immersive VR experiences. Evaluation data were collected through a structured questionnaire administered to 271 primary and secondary school students, employing XR-relevant constructs including Challenge/Satisfaction/Enjoyment, Ease of Use, Usefulness/Knowledge, Experiential and Situated Learning, Interaction/Collaboration, and Intention to Reuse. In addition, accompanying teachers provided supplementary qualitative feedback to support the interpretation of the findings under authentic field conditions. Descriptive statistical analysis indicated consistently high scores across all constructs (M = 3.27–4.40, SD = 0.41–0.64). Pearson correlation analysis revealed strong associations between Experiential/Situated Learning and Usefulness/Knowledge (r = 0.737), Experiential/Situated Learning and Challenge/Satisfaction/Enjoyment (r = 0.642), Intention to Reuse and Challenge/Satisfaction/Enjoyment (r = 0.635), as well as Usefulness/Knowledge and Challenge/Satisfaction/Enjoyment (r = 0.619). Multiple regression analyses further supported key relationships, including Usefulness/Knowledge as a predictor of Experiential/Situated Learning (β = 0.57, p < 0.001), Experiential/Situated Learning as a predictor of Challenge/Satisfaction/Enjoyment (β = 0.47, p < 0.001), and Interaction/Collaboration as a predictor of Intention to Reuse (β = 0.31, p < 0.001). Intention to reuse was mainly associated with interaction and collaboration, enjoyment and motivation, perceived usefulness/knowledge, and ease of use. Overall, the findings indicate that XR-supported outdoor learning is positively associated with key experiential, emotional, social, and perceived learning dimensions when embedded within a coherent pedagogical framework. Full article

Academic anxiety frequently emerges when students perceive academic demands as uncertain, uncontrollable, or threatening. Intolerance of uncertainty is widely recognized as a key cognitive antecedent of such anxiety, influencing how learners appraise stressors and mobilize coping resources. This study investigates the relationships among intolerance of uncertainty, academic self-efficacy as a coping mechanism, and academic resilience among vocational high school students in a collectivist educational context. Data were collected from 387 vocational high school students across Istanbul, Turkey via online forms. Contrary to expectations, the results revealed that intolerance of uncertainty positively affects academic self-efficacy. Furthermore, academic self-efficacy was positively associated with academic resilience. Academic self-efficacy partially mediated the relationship between these two variables. These findings provide new insights into how uncertainty is managed in collectivist educational contexts and suggest directions for future educational practices and research. Full article

Background and Objectives: Rates of obesity have been consistently increasing in recent years across all age groups, with a notable rise among young people. Obesity represents a persistent inflammatory condition and a key contributor to various chronic health problems, such as cardiovascular disorders, metabolic abnormalities, cancer, and psychological conditions. The move from high school to university is a transitional phase accompanied by specific pressures that can affect both body weight control and mental health in students. This cross-sectional investigation aimed to investigate potential associations between excess weight and the presence of depressive and anxiety symptoms in university populations. Methods: This cross-sectional analysis included 5298 students enrolled at universities across ten geographic areas of Greece. Participants filled out questionnaires concerning demographic information and lifestyle behaviors. Levels of depression and anxiety were measured using the Beck Depression Inventory (BDI-II) and the short form of the State Anxiety Inventory (STAI-6), respectively. Measurements of height and body weight were obtained to compute Body Mass Index (BMI). Results: The presence of overweight or obesity among students was significantly and independently related to female sex, urban residence, living independently, tobacco use, and lower academic performance (p = 0.0103, p = 0.0102, p = 0.0203, p = 0.0075, and p = 0.0168, respectively). Individuals reporting insufficient physical activity had 85% higher odds of being overweight or obese (p = 0.0068). Similarly, participants experiencing depressive or anxious symptomatology had more than double odds of excess body weight compared with those without such symptoms (p = 0.0015 and p = 0.0012, respectively). Furthermore, poor Mediterranean diet adherence was linked to more than a twofold increase in the odds of overweight or obesity (p = 0.0005). Conclusions: These findings offer considerable evidence that symptoms of depression and anxiety may serve as significant contributors to the development of overweight and obesity among university students. Additional longitudinal studies are strongly encouraged to substantiate these observations. Full article