Search Results (12,666)

To counter the high unmet need for family planning in urban areas of Sindh province, Pakistan, Greenstar Social Marketing began implementation of The Challenge Initiative (TCI) in collaboration with the government departments of Population Welfare and Health in eight urban districts of Sindh province. This study aimed to assess the effectiveness of TCI’s Community Health Volunteers (CHVs) on public sector service provision of family planning services in eight urban districts of Sindh province, Pakistan. The Contraceptive Logistics Management Information System (cLMIS) and District Health Information System 2 (DHIS2) were used to obtain monthly contraceptive data from June 2022 to December 2024. CHVs began implementation at different time points in each district, starting from January 2023 to October 2023, when CHVs became operational in all eight districts. Descriptive statistics and two-sample t-tests were used for data analysis. CHVs significantly improved family planning service provision, particularly for short- and long-acting methods at the facility level, with greater change observed in Department of Health facilities. This study provides preliminary evidence of the effectiveness of CHVs in increasing public sector service provision of contraceptives, particularly for Department of Health facilities. CHVs bridge the gap between the community and the facility, particularly in areas uncovered by the government’s existing mobilization staff. Full article

The healthcare needs of refugees and people seeking asylum are often broad and complex, with a higher burden of communicable diseases. There are limited data describing migrants’ experiences of accessing healthcare in Ireland. This cross-sectional study describes the experiences of migrants accessing healthcare services through an Irish Infectious Diseases clinic. Individuals attending the infectious diseases services in our hospital who had migrated to Ireland were included. Data were collected via a questionnaire, focusing on factors that may limit access to care, including communication, accessibility, cost, and stigmatisation. Seventy-six patients participated in this study. N = 20 (26%) of patients reported a commuting time of more than two hours to attend our clinic. N = 11 (15%) had experienced being unable to access healthcare in Ireland due to cost. Trust in healthcare providers was high (88%), and patient-reported satisfaction with communication was high (>90%). Persons living in direct provision services were more likely to report issues around privacy and less likely to have registered with a general practitioner. Accessibility and privacy were among the biggest challenges faced by migrants attending infectious diseases services at our centre, while communication and trust in healthcare providers were identified as areas of strength. Considering the burden of infectious diseases in migrant populations, and the challenges that certain migrant populations face in accessing healthcare, it is important to identify potential barriers to accessing care in order to ensure equitable, effective care. This study seeks to identify and describe the challenges that migrants face when accessing care through an Irish infectious diseases clinic. The results can help inform service provision and allocation of resources at a local level, while also identifying an area for further research regarding the barriers to accessing care faced by migrant communities in Ireland. Full article

Background/Objectives: Psychosocial care for siblings and caregivers of youth with cancer (SCYC) is a critical yet under-implemented component of comprehensive pediatric oncology care, as outlined by the Standards for Psychosocial Care for Children with Cancer and Their Families. Despite evidence supporting psychosocial interventions, such as integrative care interventions, as effective for stress mitigation and coping, barriers to implementation include revenue-generating funding models and siloed psychosocial disciplines, which hinder accessibility for adult caregivers within pediatric institutions and geographically dispersed families. This manuscript describes the relevant extant literature as well as a model for leveraging short-term funding opportunities and interdisciplinary collaboration to develop integrative care programs for these underserved groups. Methods: Philanthropic funding supported part-time child life specialist and creative arts therapist deployment to develop and implement integrative virtual group programs, as well as interdisciplinary integrative programs, to serve SCYC. Attendance, engagement, and qualitative feedback were used for program iteration and supported the transition to institutional funding. Results: Integrative programs provided 331 caregiver and sibling encounters during the two-year pilot. Qualitative feedback from caregivers highlighted the value of virtual services in reaching geographically dispersed families and addressing feelings of isolation among SCYC at the universal and targeted levels of care. Communication about these key outcomes led to operational funding and sustained integrated care programs. Conclusions: This manuscript illustrates a successful model of leveraging philanthropic funding to support the development of integrative care programs to serve SCYC. Future research should focus on refining the clinical and financial feasibility of such models and assessing their impact on family well-being. Full article

This study aims to explore whether the dual-scale management model, formed by integrating service-scale management with land-scale management, can further break through the benefit limits of single land-scale management and unlock additional profit potential in agricultural scale operations. This study used data from a 2024 questionnaire survey of 2166 farming households in Anhui Province and employed a coupling coordination degree model to measure the level of dual-scale management. Subsequently, we utilized OLS regression and mediation effect models to empirically examine the impact of dual-scale management on agricultural operational benefit and their underlying mechanisms. We find that dual-scale management significantly improves agricultural operational benefit. Our measurements show that dual-scale management not only breaks through the upper limit of the optimal operating area inherent in single land-scale management but also yields a greater improvement in agricultural operational benefit than single land-scale management. Heterogeneity analysis reveals that dual-scale management significantly enhances the agricultural operational benefit of farmers in plain areas and farmers with fully developed high-standard farmland. Mechanism analysis indicates that dual-scale management enhances agricultural operational benefit through an endogenous efficiency improvement mechanism and an exogenous risk-burden-sharing mechanism. These findings suggest that fostering a synergistic development system for land-scale management and service-scale management is conducive to improving the economic returns for land scale operators and unlocking new dividend spaces for agricultural scale operation in China’s post-land transfer era. Full article

Cooperative Intelligent Transport Systems (C-ITS) have emerged as a key enabler of more efficient, safer, and environmentally sustainable road traffic by allowing vehicles and infrastructure to exchange information and coordinate behavior. To evaluate their benefits, impact assessment studies are essential. However, most existing studies focus on individual C-ITS services in isolation, overlooking how combined deployments influence outcomes. This study addresses this gap by presenting the first systematic evaluation of individual and joint deployments of Cooperative Adaptive Cruise Control (CACC) and Green Light Optimal Speed Advisory (GLOSA) under diverse conditions. A dual-model simulation framework is applied, combining controlled artificial networks with calibrated real-world corridors in Upper Austria. This allows both statistical testing and validation of plausibility in real-world contexts. Key performance indicators include travel time and CO₂ emissions, evaluated across varying lane configurations, numbers of traffic lights, demand levels, and equipment rates. The results demonstrate that C-ITS effectiveness is strongly context-dependent: while CACC generally provides larger efficiency gains, GLOSA yields consistent emission reductions, and the combined deployment offers conditional synergies but may also diminish benefits at high demand. The study contributes a guideline for selecting service configurations based on site conditions, thereby providing practical recommendations for future C-ITS rollouts. Full article

Background: Communication difficulty restricts education, healthcare, and social participation, yet population-level data for Saudi Arabia have been scarce. This study analysed the 2017 Saudi National Disability Survey to estimate prevalence, describe severity and demographic patterns, and identify factors linked to these difficulties. Objectives: We aimed to estimate national and regional prevalence, assess severity, and gender differences, and identify socio-demographic and disability-related correlates. Methods: A cross-sectional, two-stage stratified cluster sample of 33,575 households (weighted N = 20,408,362 citizens) provided self-reported data on communication difficulty and socio-demographics. Weighted frequencies described prevalence and multivariable logistic regression identified independent correlates. Results: Among all Saudi citizens, 7.1% reported at least one functional difficulty, and of this group 15.7%—equivalent to 1.1% of the total population (n = 226,510)—had a communication difficulty; within that communication difficulty stratum, (n = 185,508) (0.9% of all citizens) experienced it alongside additional impairments, whereas (n = 41,002) (0.2% of all citizens) reported communication difficulty in isolation. The communication difficulties exhibit significant regional variation, ranging from 0.45% in Najran to 1.55% in Aseer. Most cases were classified as being associated with some difficulty (72%); females were over-represented in the extreme category despite a modest male excess overall (adjusted odds ratio [AOR] = 1.09). Higher education, married status, and bilateral first-cousin marriage (AOR = 1.22) were associated with greater risk. Chronic disease (44%) and perinatal causes (13%) predominated, and 84% of cases co-occurred with at least one other disability. Independent predictors included a long duration (AOR = 4.18), disease or delivery-related cause, and consanguinity. Conclusions: Findings highlight geographically clustered need, genetic risk factors, and substantial multimorbidity, indicating the importance of region-specific screening, premarital counselling, and integrated rehabilitation within chronic disease services. Full article

The paper presents the main features of a Web-GIS platform designed to compute real-time scenario-based seismic risk assessments at the national level. Based on the Italian experience, the platform enables DRM scientist and policymakers to readily generate seismic scenarios supporting the entire DRM cycle, including training, emergency planning, calibrating operations during response, and providing seismic risk estimates for National Disaster Risk Assessment or seismic risk reduction programs. The platform is immediately operational, relying on preloaded freeware datasets on exposure and vulnerability, and requiring only basic earthquake parameters to perform real-time analysis. At a later stage, these datasets should be replaced with more detailed and accurate national-level data. The platform generates earthquake impact assessments that include physical damage, economic and human losses, and key emergency response indicators, such as estimated displaced population, required tent camps, and EMT and USAR needs. Its key innovation lies in the ability to operate at the national scale, offering immediate usability with the possibility of further customization. As a web-based service with a user-friendly graphical interface, it is particularly suited for civil protection and DRM experts. Full article

Digital transformation has fundamentally altered how individuals manage their finances. The expansion of financial technologies and the digitalization of banking services underscore the need for digital financial literacy, defined as the ability to safely use financial applications and make informed decisions within virtual environments. This study examined the perceptions of financial application use across age groups and their corresponding level of digital financial literacy. This exploratory study used a convenience sample of 41 semi-structured interviews conducted in 2025. The data were analyzed using content analysis and descriptive statistics. The findings indicated that most participants prioritized digital apps over traditional channels and expressed confidence in their use, although concerns about data security remained. Participants identified key advantages, including convenience, efficiency, and centralized access, yet few used apps for financial planning. Most respondents demonstrated an intermediate level of digital knowledge, with limited proficiency in executing complex financial tasks. Perceptions revealed both optimism and apprehension: while participants valued the practicality of digital tools, they also recognized risks such as fraud, exclusion of vulnerable groups, and technological dependence. The limited and non-representative sample limits generalization, suggesting the need for broader surveys. Enhanced public policies promoting digital financial education in Brazil are recommended. Full article

Background/Objectives: In the age of digitalization, nomophobia has emerged as a relevant issue, especially among university students who utilize smartphones heavily for academic and social purposes. The Stressor–Strain–Outcome (SSO) framework explains the relationship between stressors, strain, and outcomes. Stressors such as nomophobia induce psychological strain. This strain subsequently influences outcomes like mindfulness. Nomophobia has been linked to higher distress, including depression, anxiety, and stress, that can negatively impact students’ focus. However, the mechanisms by which nomophobia impacts mindfulness remain less explored. Hence, this study aims to analyze the mediating effect of distress on the relation between student’s nomophobia and mindfulness. Methods: In this quantitative study, the researcher employed a structured close-ended survey to collect data from 723 students at the University of Ha’il in Saudi Arabia. Nomophobia was measured using the Nomophobia Questionnaire (NMP-Q). The level of distress was measured using the Depression, Anxiety, and Stress scale (DASS-21) Furthermore, the assessment of mindfulness was conducted using the Mindful Attention Awareness Scale (MAAS). Structural equation modeling was utilized to test the hypotheses of this study. Results: The results from PLS-SEM indicate that nomophobia did not directly reduce mindfulness, as its effect was statistically non-significant (β_1 = −0.052, p-value = 0.168). This suggests that nomophobia alone may not weaken focus. However, it significantly increased distress, particularly depression (β_2a = 0.327, p-value < 0.001), anxiety (β_2b = 0.294, p-value < 0.001) and stress (β_2c = 0.259, p-value < 0.001). In plain terms, students with higher nomophobia reported more depression and stress, which in turn reduced mindfulness. Anxiety, however, did not significantly affect mindfulness (β_3b = 0.006, p-value < 0.933), indicating its influence may be negligible or context-specific. Mediation analysis confirmed indirect effects of nomophobia on mindfulness through depression (β_4a = −0.096, p-value < 0.001) and stress (β_4c = −0.045, p-value < 0.020). Together, these mediators explained a substantial portion of the variance in mindfulness. Conclusions: The findings align with the SSO model, indicating that nomophobia acts as a stressor, exacerbating distress, which in turn reduces mindfulness. From a practical perspective, the results highlight the need for comprehensive student support. Universities should integrate digital wellness programs, stress-management resources, and mindfulness training into their services. Limitations and Future Research: The cross-sectional design and convenience sampling restrict causal inference and generalizability. Future studies should employ longitudinal research designs. They should also examine diverse cultural contexts. In addition, researchers should investigate potential mediators such as social support and sleep quality. Full article

Introduction: Tuberculosis (TB) remains a public health concern, and people at risk for TB are hesitant to seek care. The first South African National TB prevalence survey, conducted in 2017–2019, found that most participants with TB symptoms did not seek care for TB. In 2022, an estimated 23% of people with TB in South Africa were undiagnosed, contributing to the country’s burden of “missing” TB cases. This study explores health-seeking behaviour among people with TB (PwTB) in South Africa, focussing on barriers and facilitators to care-seeking and the quantification of TB-related stigma from a patient and community perspective. Methods: We conducted a mixed-method study in the City of Johannesburg (COJ) Metropolitan Municipality from February to March 2022. PwTB aged 18 and older initiating TB treatment for microbiologically confirmed pulmonary TB were recruited from three primary healthcare facilities in the COJ. After providing written informed consent, they participated in a one-time, in-depth, face-to-face interview. The interviews were digitally recorded and conducted by trained facilitators. We used thematic analysis with deductive approaches to develop themes. We used the Van Rie TB stigma assessment scale to quantify perceived stigma. Results: We interviewed 23 PwTB with an overall median age of 39 years and 14 (61%) males. Patient-level barriers to accessing TB care included visiting traditional healers and pharmacists before their TB diagnosis; wrong or missed diagnosis by private doctors; work commitments; scarcity of resources to attend the clinic or walk long distances; perceived and experienced stigma; and a lack of TB knowledge. Facility-level barriers included long clinic queues and uncertainty about where to receive TB care in the clinic. Facilitators for TB care-seeking included being in contact with someone who had TB, receiving encouragement from family, or having knowledge about TB transmission and early diagnosis. The overall median total stigma score among 21 PwTB was 53 (IQR: 46–63), with median community and patient stigma scores of 25 (IQR: 22–30) and 31 (IQR: 21–36), respectively. Conclusions: We found important considerations for the TB programme to improve the uptake of services. Since PwTB consult elsewhere before visiting a facility for TB care, TB programmes could establish private–public partnerships. TB programmes could also increase TB awareness in the community, especially among males, and mobile clinics could be considered to assist with TB case detection and treatment provision. Applying behavioural design techniques and co-designing interventions with patients and providers could improve TB health-seeking behaviours. Full article

Shaft deflection degrades roller alignment and intensifies stress concentration/edge effects at roller-ends and raceway edges, ultimately compromising service performance of tapered roller bearings (TRBs). Therefore, a dynamic model was developed for a TRB subjected to a deflected shaft in which Johnson’s load–deformation relationship was applied to reflect non-uniform cross-sectional structures of the tapered rollers and raceways, viscous damping was integrated into the roller/cage interaction, and friction actions at the raceways and flange areas were treated separately. Then, moment load and angular misalignment of the tapered roller were analyzed under various shaft deflection and operating conditions. Results indicate that tilt angle remains orders of magnitude smaller than skew angle. Shaft deflection amplifies both skew and tilt, and the influence level is proportional to the bearing size. Centrifugal effect primarily affects skew motion, whereas gyroscopic effect mainly influences tilt motion. Axial forces exert greater influence on roller skew than tilt. The flange typically constrains roller skew, whereas both raceways may induce bidirectional tilt/skew motion. Full article

Background/Objectives: Leisure participation is vital for children’s development and family inclusion, yet families of children with developmental delays and disabilities face significant barriers. Guided by a health literacy framework, this study examined how personal and organizational health literacy shape access to inclusive leisure opportunities. Methods: Semi-structured interviews were conducted with 14 caregivers of young children (aged 2 to 6 years) with developmental delays and disabilities. A qualitative content analysis was applied to identify family and environmental factors shaping leisure participation. Results: Families with stronger personal health literacy engaged in diverse leisure activities, prioritizing children’s development through park visits and structured home routines. In contrast, weak organizational health literacy—reflected in limited inclusive facilities and support systems—restricted opportunities, increased caregiver stress, and forced adaptations such as traveling farther or rescheduling activities. These barriers underscored families’ vulnerability to exclusion while also highlighting their resilience in navigating daily life. Conclusions: This study demonstrates that health literacy functions at both personal and organizational levels to shape leisure participation. Beyond identifying barriers, it shows that leisure is intertwined with developmental needs and school readiness. By applying a health literacy lens, the study contributes to understanding family dynamics in inclusive leisure and underscores the need for responsive community services and inclusive policies. Full article

Access to home- and community-based services (HCBSs) varies substantially between states. Yet, it is unknown how state-level policies and administrative factors impact consumer-reported unmet service needs, an important indicator of HCBS access and quality. Using the National Core Indicators—Aging and Disability Adult Consumer Survey (2016–2019; n = 13,654 community-dwelling older adults, 13 states), we examined associations between unmet HCBS needs with four state-level factors: HCBS spending relative to institutional care spending, HCBS spending per client, percentage of Medicaid beneficiaries in managed care, and Medicaid expansion; and funding program. In the adjusted logistic regression model, the odds of overall unmet HCBS needs were lower with higher percentage Medicaid beneficiaries in managed care (adjusted odds ratio [aOR], 0.92; 95% confidence interval [CI], 0.89–0.96) and Medicaid expansion (aOR, 0.80; 95% CI, 0.73–0.87) but greater with higher HCBS spending relative to institutional care spending (aOR, 1.19; 95% CI, 1.11–1.28). Compared to Medicaid waiver, odds of unmet HCBS needs were significantly lower among consumers in Managed Long-Term Services and Supports (aOR, 0.67; 95% CI, 0.61–0.74) and Program of All-Inclusive Care for the Elderly (PACE; aOR, 0.39; 95% CI, 0.31–0.49). State policies and administrative factors are important place-based determinants of HCBS consumers’ unmet HCBS needs/access; and warrant consideration in HCBS quality assurance and improvement. Full article

This study investigates the transverse loads acting on high-speed train bogie frames under actual service conditions. To enable direct identification, the locating arms were instrumented as bending sensors and calibrated under realistic lateral-stop constraints, ensuring robustness of the measurement channels. Field tests were conducted on a CR400BF high-speed EMU over a 226 km route at six speed levels (260–390 km/h), with gyroscope and GPS signals employed to recognize typical operating conditions, including straights, curves, and switches (straight movement and diverging movements). The results show that the proposed recognition method achieves high accuracy, enabling rapid and effective identification and localization of typical operating conditions. Under switch conditions, the bogie frame transverse loads are characterized by low-frequency, large-amplitude fluctuations, with overall RMS levels being higher in diverging switches and straight-through depot switches. Curve parameters and speed levels exert significant influence on the amplitude of the transverse-load trend component. On curves with identical parameters, the trend-component amplitude exhibits a quadratic nonlinear relationship with train speed, decreasing first and then increasing in the opposite direction as speed rises. In mainline curves and straight sections, the RMS values of transverse loads on Axles 1 and 2 scale proportionally with speed level, with the leading axle in the direction of travel consistently producing higher transverse loads than the trailing axle. When load samples are balanced across both running directions, the transverse load spectra of Axles 1 and 2 at the same speed level show negligible differences, while the spectrum shape index increases proportionally with speed level. Full article

Omni-channel retailers arise to address the deficiencies in consumers’ online shopping experiences; the resulting competition between such retailers and traditional online platforms presents substantial challenges for green product manufacturers. A three-level game model is established to examine a manufacturer’s green contract design (product pricing and greenness determination) and mode selection under the competition between an online platform and a new retailer providing omni-channel services to end customers. The manufacturer can select between two modes: supplying a green product to the online platform and new retailer (mode RR) or selling it directly through the online platform and reselling it to the new retailer (mode PR). Our findings indicate that, first, even if the relationship between the manufacturer and new retailer has changed from cooperation under mode RR to competition and cooperation under mode PR, the manufacturer still favors two-channel sales over single-channel sales and affects consumer channel choices to adjust market shares through mode selection. Second, regarding the impacts of the key parameters on the manufacturer, downstream e-commerce platform retailers and environment are intricate and nuanced. While raising the omni-channel service level enhances profitability in the new retailer across both modes, its environmental impacts differ significantly between them. Additionally, it can harm the online platform in some cases. Nevertheless, when the parameters fall within suitable ranges, the manufacturer and both downstream retailers have a consistent preference for improved omni-channel services under both modes. Finally, there is a significant divergence in mode preferences among the manufacturer and both downstream platform retailers. Due to the first-mover advantage, the manufacturer opts for mode RR over mode PR in most cases. Notably, within a specific range of parameters, they consistently prefer mode RR, which also proves beneficial for the environment, resulting in a Pareto optimal outcome. This proposes a concrete cooperation mechanism among the manufacturer, retailers, and consumers from quantitative insights, which can promote green products to achieve the objective of low-carbon environmental protection. Full article