Search Results (7,034)

Background: Celiac disease (CD) is a chronic, immune-mediated condition requiring lifelong adherence to a gluten-free diet. In children, CD can negatively impact not only physical health but also psychological well-being and quality of life. The burden of dietary restrictions, social limitations, and emotional stress may lead to increased anxiety and depressive symptoms. This study aims to compare the quality of life, anxiety, and depression levels in children with celiac disease to those of healthy peers without chronic illness. Methods: The research involved a total of 129 individuals aged 8–18 years (64 with celiac disease and 65 healthy volunteers) and their parents. To assess children with celiac disease and healthy children, we used a sociodemographic form that we created, along with the State-Trait Anxiety Inventory (STAI), Trait Anxiety Inventory (TAI), Children’s Depression Inventory (CDI), Pediatric Quality of Life Inventory (PedsQL), and Parent Quality of Life Inventory tests. Results: Celiac patients’ diet adherence, parental education level, and family income were found to be significantly associated with quality of life, as well as levels of depression and anxiety. (p < 0.037, p < 0.04, p < 0.004, respectively). Celiac patients had significantly lower BMI SDS (mean −0.55 ± 1.13, p < 0.001) and height SDS scores (mean −0.49 ± 1.28, p < 0.017). Key factors negatively affecting the quality of life in individuals with celiac disease were difficulty adhering to the diet and low family income levels. Conclusions: Elevated anxiety with reduced quality of life highlights the importance of integrating psychosocial support into the routine care of children with celiac disease. A holistic treatment approach that considers the psychosocial well-being of children can significantly improve their quality of life. Full article

Background and Objectives: The COVID-19 pandemic placed substantial mental and physical burdens on healthcare workers, particularly nurses. In the post-pandemic period, sustained stress, elevated mental workload and disturbed sleep may continue to affect well-being and job performance. This study aimed to assess perceived stress levels, occupational stress, and sleep quality among Hungarian nurses, while identifying key demographic, occupational, and behavioral predictors. Materials and Methods: A cross-sectional, quantitative study was conducted from April to July 2022 among nurses employed in Hungarian general hospitals (N = 418). Data were collected via an online self-administered questionnaire. Stress and sleep quality were measured using the Perceived Stress Scale (PSS-14), Expanded Nursing Stress Scale (ENSS), and Groningen Sleep Quality Scale (GSQS). Statistical analysis included descriptive statistics, ANOVA, post hoc tests, t-tests, and Pearson’s correlation (p < 0.05). Results: The mean PSS-14 score was 27.82 (SD = 7.82), indicating moderate stress. Sleep quality was poor (mean GSQS = 7.29, SD = 4.28), with significant positive correlation with perceived stress (r = 0.442, p < 0.001). Low income, lower education, and high coffee or alcohol consumption, and multiple night shifts were significantly associated with higher stress and poorer sleep quality. Occupational stress and mental workload, as measured by ENSS, was highest in internal medicine (mean = 122.16, SD = 37.09; p = 0.033). The most burdensome ENSS subscale was “workload” (mean = 2.30, SD = 0.92), with “not enough staff to adequately cover the unit” identified as the most stressful item. Additional cognitive and emotional workload components included dealing with violent patients and a lack of emotional preparedness in supporting families. Conclusions: Post-COVID nurses in Hungary experience moderate stress and impaired sleep. Excessive workload, emotional demands, and shift patterns significantly contribute to psychological and cognitive strain. Institutional and policy-level interventions are needed to reduce occupational stress and promote workforce resilience. Full article

Both behavioral intentions and structural constraints shape household waste disposal in low-resource settings. This study integrates the Theory of Planned Behavior (TPB) with Environmental Justice (EJ) to examine informal waste disposal in Vhembe District, South Africa, a region marked by infrastructural deficits and uneven municipal services. A cross-sectional survey of 399 households across four municipalities assessed five disposal behaviors, including river dumping and domestic burial. Only 8% of households used formal bins, while over 50% engaged in open or roadside dumping. Although education and income were inversely associated with harmful practices, inadequate service access was the most significant constraint on formal disposal. Logistic regression revealed that rural residents and households in underserved municipalities were significantly more likely to engage in hazardous methods, regardless of socioeconomic status. These findings extend TPB by showing that perceived behavioral control reflects not only psychological agency but also material and institutional limitations. By reframing informal disposal as a structurally conditioned response rather than a behavioral deficit, the study advances EJ theory and provides a transferable TPB–EJ framework for decentralized, justice-oriented waste governance. The results underscore the need for Sustainable Development Goal (SDG)-aligned interventions that integrate equitable infrastructure with context-sensitive behavioral strategies. Full article

Smallholder farmers play a pivotal role in food production and rural development in South Africa. However, their productivity is often constrained by reliance on rainfed agriculture and the underutilisation of innovative technologies such as irrigation systems. This study assessed the impact of innovative irrigation system (IIS) use on crop yield among smallholder crop farmers (SCFs) in Mbombela Local Municipality. Focusing on vegetables and agronomic crop producers. Primary data was collected from 308 SCFs using a structured questionnaire through descriptive and cross-sectional survey design. A Probit regression model was used to estimate the probability of using an IIS, while Propensity Score Matching (PSM) estimated the average treatment effect on the treated (ATT) in terms of yield. The results reveal that age group (p = 0.080), main source of off-farm income (p = 0.042), and high input costs (p = 0.006) significantly determined IIS use. Impact analysis confirms that users of IISs achieved higher yields than non-users. The study concludes that innovative irrigation technologies can significantly improve smallholder productivity. It recommends that policymakers and government bodies prioritise scaling up access to IIS, introduce subsidies or low-interest financing schemes to alleviate the IIS usage costs, and strengthen extension services to provide targeted training on irrigation scheduling, system maintenance, and water-use efficiency. Full article

Urban tree planting on single-family-home lots represents a critical yet underexplored component of municipal greening strategies. This study examines residents’ perceptions of tree planting in Westpointe, a diverse neighborhood in Salt Lake City, Utah, as part of the city’s Reimagine Nature Public Lands Master Plan development effort. Through a mixed-methods approach combining qualitative interviews (n = 24) and a tree signup initiative extended to 86 residents, with 51 participating, this research explores the complex interplay of demographic, economic, social, and infrastructure factors influencing residents’ willingness to plant trees on single-family-home lots. The findings reveal significant variations based on gender, with women expressing more positive environmental and aesthetic motivations, while men focused on practical concerns including maintenance and property damage. Age emerged as another critical factor, with older adults (65+) expressing concerns about long-term maintenance capabilities, while younger families (25–44) demonstrated future-oriented thinking about shade and property values. Property characteristics, particularly yard size, significantly influenced receptiveness, with owners of larger yards (>5000 sq ft) showing greater willingness compared to those with smaller properties, who cited space constraints. Additional barriers, i.e., maintenance, financial, and knowledge barriers, included irrigation costs, lack of horticultural knowledge, pest concerns, and proximity to underground utilities. Geographic analysis revealed that Spanish-speaking social networks were particularly effective in promoting tree planting. The study contributes to urban forestry literature by providing nuanced insights into single-family homeowners’ tree-planting decisions and offers targeted recommendations for municipal programs. These include gender-specific outreach strategies, age-appropriate support services, sliding-scale subsidy programs based on property size, and comprehensive education initiatives. The findings inform evidence-based approaches to increase urban canopy coverage through private property plantings, ultimately supporting climate resilience and environmental justice goals in diverse urban neighborhoods. Full article

Background and Objectives: Congenital abnormalities are a leading cause of neonatal morbidity and mortality and are frequently detectable through prenatal ultrasound. While widely implemented in high-income countries, such screening remains inconsistently applied in low- and middle-income regions. This study aimed to estimate the prevalence of congenital abnormalities identified via prenatal ultrasound in Lebanon and to explore associated maternal, obstetric, and psychosocial factors. Methods: A multicenter retrospective observational study, supplemented by follow-up interviews, was conducted in five Order of Malta medical centers. Pregnant women in their second trimester underwent an obstetric ultrasound, and data were collected through structured questionnaires and follow-up phone interviews. Variables included maternal demographics, obstetric history, anxiety levels (GAD-7 scores), and ultrasound findings. Results: A total of 426 pregnant women were enrolled (mean age: 28.8 ± 5.9 years). The overall prevalence of congenital abnormalities was 13.1%. Growth abnormalities were observed in 8.5% of fetuses and were significantly associated with obstetric complications and the presence of multiple abnormalities. Morphological malformations were found in 10.1% of cases and were more common among women of advanced maternal age, those with a history of anomalies, and those reporting elevated anxiety scores. Combined abnormalities, as well as growth and morphological malformations, were significantly associated with higher parity, prior anomalies, and current pregnancy complications. Conclusions: Prenatal ultrasound is essential for early detection of congenital abnormalities, facilitating timely intervention and improved neonatal outcomes. These findings emphasize the need to integrate systematic screening into prenatal care in Lebanon and for ongoing research to identify context-specific risk factors. Full article

Hispanic breast cancer survivors reported worse quality of life, and fatalism is considered one of the mediators for this disparity. This study aimed to identify the factors associated with fatalism within a diverse Hispanic population. Hispanic origin was self-reported, and the Multidimensional Fatalism Measure questionnaire, a validated tool that measures fatalism across multiple dimensions, was used to assess fatalism. A total of 390 women, consisting of 210 Puerto Ricans, 34 Colombians, 29 Dominicans, 25 Cubans, 24 Venezuelans, 22 Mexicans, and 46 individuals of other Hispanic backgrounds, completed the fatalism assessment. The mean fatalism score was 16.4 (95% CI = 15.8–17.0), characterized by a high internal locus of control and strong religious beliefs, along with moderate beliefs in luck and a low external locus of control. The higher fatalism scores were reported in Dominican, Mexican, and Venezuelan groups, while Colombians reported the lowest score. Multivariable analysis showed that Colombians (β = −4.0), individuals with higher household incomes (β = −2.3 for USD 20,000–USD 75,000, β = −2.4 for ≥75,000), higher education levels (β = −1.9), and those using English more frequently at home (β = −2.0) reported lower fatalism compared to their reference group. To enhance the quality of life for these survivors, culturally tailored interventions should focus on improving perceived control and mitigating fatalism. Full article

Encouraging farmers to adopt low-carbon agricultural technologies is a vital strategy for addressing climate change and fostering a harmonious relationship between humans and nature. An initial step is understanding the formation of farmers’ willingness to adopt them. This study adopts an integrated theoretical framework combining the Theory of Planned Behavior and the Norm Activation Model to explore the determinants and formation process of farmers’ adoption intentions. Using survey data from 1008 farmers in Shandong Province, the study employs Structural Equation Modeling to empirically examine the influencing factors and mechanisms underlying farmers’ willingness to adopt low-carbon agricultural technologies. The results reveal that perceived behavioral control, subjective norm, and attitudes toward behavior serve as the critical external driving forces for the formation of adoption intention, whereas personal norms act as the core intrinsic motivation by fostering farmers’ sense of ecological responsibility. Multi-group analysis reveals socio-demographic heterogeneity: perceived control drives males and wealthier, less-educated farmers; subjective norms influence younger, educated groups; attitudes affect females and low-income farmers, while personal norms dominate among older farmers. Therefore, policy design should enhance farmers’ resource accessibility, strengthen social demonstration, and cultivate ecological ethics with tailored incentives, thereby promoting the widespread adoption of low-carbon agricultural technologies. Full article

This study presents a systematic literature review and bibliometric analysis focused on female-led nanoenterprises in rural contexts, a marginal yet increasingly relevant category within enterprise research. Despite the growing attention to micro and small businesses, nanoenterprises—defined as unipersonal, informal, low-income productive units—remain underexplored and largely excluded from formal economic frameworks. Using the PRISMA 2020 guidelines with the 10-step B-SLR approach, 12 peer-reviewed articles were selected through a targeted search combining terms such as “nanoenterprise”, “women”, and “rural”. The analysis included citation counts, journal impact, country of origin, and thematic focus. Findings indicate conceptual and geographic fragmentation in existing research, with studies concentrated in Latin America, Asia, and Africa, and focused primarily on commerce, personal services, and subsistence agriculture. Gender emerges as a structural axis, as women face compounded barriers in digital access, credit, and formal recognition. The review reveals a lack of theoretical consolidation, comparative studies, and longitudinal research. This work contributes by articulating the distinct nature of nanoenterprises, proposing a research agenda, and highlighting their role in fostering economic inclusion, resilience, and empowerment among marginalized populations. The results call for inclusive public policies and scholarly frameworks that go beyond traditional models of entrepreneurship. Full article

There is increasing use of modern medicine globally to manage cardiovascular diseases (CVDs). However, many people, especially in low-to-middle-income countries, still rely on traditional medicinal plants for their daily health needs. However, limited studies have explored the use of these remedies. Therefore, this narrative review aimed to evaluate the potential of Sclerocarya birrea (S. birrea) in managing diabetes, dyslipidemia, inflammation, and hypertension, including its effects on oxidative stress. This study reviewed evidence from PubMed, Web of Science, and ResearchGate, published in these databases up to 30 April 2025. The evidence showed that S. birrea had the potential to preserve cardiometabolic health and reduce CVD-associated risk factors. Notably, S. birrea improved glucose metabolism, inflammation, hypertension, and oxidative stress. This plant exhibits antihyperglycemic effects by activating adenosine monophosphate-activated protein kinase (AMPK) and inhibiting gluconeogenesis and the activities of carbohydrase. It also ameliorates dyslipidemia by modulating the activities of peroxisome proliferator-activated receptor alpha (PPARα) and increasing fatty acid oxidation. The anti-inflammatory potential of S. birrea is modulated by the activation of PPARα, which inhibits nuclear factor kappa beta (NF-κβ) and decreases the production of inflammatory cytokines. Its antioxidant property is attributed to its ability to increase antioxidant enzymes like catalase (CAT), superoxide dismutase (SOD), and glutathione (GSH), which are known to counteract oxidative damage. However, it is important to note that different parts of the plant had varying impacts on CVD risk factors, depending on whether the study was conducted preclinically or clinically. Therefore, its extract should be explored as a potential remedy for the management of CVD risk factors, especially in areas where access to healthcare is limited. Full article

The health technology assessment (HTA) is a multidisciplinary process utilized to determine the clinical, economic, social, and ethical value of new health technologies before they are incorporated into healthcare systems. In the case of rare diseases, such as Cystic Fibrosis (CF), challenges arise due to limited evidence and high treatment costs. Indeed, although CF transmembrane conductance regulator (CFTR) modulators are breakthrough therapies for CF, their incorporation into public health systems has been complex with considerable challenges, especially in low- and middle-income countries. This article presents a descriptive and exploratory case study of the regulatory and policy journey for CFTR modulators to be approved in Brazil. Based on a narrative review and document analysis, we highlight the importance of building lay society knowledge to shape policy decisions and promote equitable access to innovative therapies. In parallel, we critically reflect on the HTA process and highlight efforts in the training, education, and coordination required to enable meaningful public engagement and landmark achievements. Full article

Background/Objectives: Asthma is a condition caused by chronic lower airway inflammation. Its primary treatment focuses on managing the condition and reducing the frequency of exacerbation episodes. Monitoring the level of asthma control among adults is essential for both clinical care and public health planning. This systematic review aimed to assess the level of asthma control among adults in Saudi Arabia and to determine the prevalence of controlled asthma in this population. Methods: The literature search was conducted using PubMed. We included all English-language, empirical, quantitative studies that investigated the prevalence of asthma control among Saudi adults. National Institutes of Health (NIH) Study Quality Assessment Tools guided determination of the quality of the included studies. This review is registered with PROSPERO (CRD42024484711). Results: Of the 107 initially identified studies, 17 met the inclusion criteria. Quality assessment tool rated 11 studies as good, 5 as fair, and 1 as poor. Most of the included studies used cross-sectional design from different geographical locations and varied in sample size. Overall, the prevalence of uncontrolled asthma among Saudi adults ranged from 23.4% to 68.1%. In some studies, well-controlled asthma was reported in as few as 3% of patients. Factors associated with uncontrolled asthma included lower educational attainment, unemployment, low income, female gender, tobacco use, poor medication adherence, and lack of regular medical follow-up. Environmental triggers and comorbid conditions, such as allergic rhinitis, were also frequently cited as contributing factors. Conclusions: Asthma control among adults in Saudi Arabia remains a significant public health concern. Improving outcomes requires a multifaceted approach that includes patient education, regular follow-up care (including pulmonary function tests, asthma severity assessments, and personalized treatment plans), and broader public health initiatives aimed at reducing exposure to allergens and pollutants. Strengthening primary care services and implementing nationwide asthma management programs may play a critical role in enhancing disease control and improving quality of life. Continued research in this field is strongly recommended. Full article

Background: Nursing students usually face excessive academic and clinical demands that negatively impact their sleep quality. Physical activity (PA) has been proposed to enhance sleep, yet few investigations have focused on this correlation within the Saudi environment. The purpose of this research was to determine the relationship between PA and sleep quality in Saudi nursing students. Methodology: A cross-sectional study was conducted among a sample of 554 nursing students from different universities in Saudi Arabia. The International Physical Activity Questionnaire–Short Form (IPAQ-SF) and the Pittsburgh Sleep Quality Index (PSQI) were used to collect data. Snowball sampling was used to recruit the participants through social media. Descriptive statistics, Pearson correlation, and inferential tests were employed for the analysis. Results: Most participants were female (85.1%) and aged 18–34 years (95.5%). LPA levels were reported by 59.6% of students, and only 8.2% engaged in VPA. The majority (91%) reported poor sleep duration (<5 h), and 57.4% had poor sleep efficiency. Overall, 86.7% of students experienced poor sleep quality. Gender and GPA were significantly associated with both PA and sleep quality. Female students and those with lower GPAs were more likely to report LPA and poor sleep. Marital status was also associated with higher levels of VPA. No significant associations were found with age, academic year, region, income, or parental education. A statistically significant positive correlation was found between PA and sleep quality (r = 0.192, p < 0.001), suggesting that increased PA is modestly associated with better sleep. Conclusion: The research shows a high rate of poor sleep and low physical activity in nursing students, indicating an alarming health trend. Although PA was linked significantly to better sleep, the modest strength indicates the necessity for multi-component interventions. Structured PA programs and sleep hygiene education should be incorporated into nursing curricula by universities to foster students’ well-being and academic performance. Full article

Against the backdrop of pervasive land fragmentation and high transaction costs, organized land transfer has emerged as a growing trend in China’s agricultural land market, facilitating the transition toward moderate-scale farming. Based on survey data from 1472 households across 72 villages in Jiangsu Province, this study investigates the impact of organized land transfer on agricultural land allocation efficiency and explores the underlying mechanisms. The results show that organized land transfer significantly enhances agricultural land allocation efficiency. This finding proves to be robust across a series of robustness analyses. Specifically, organized land transfer enhances land allocation efficiency, primarily by enhancing transfer stability, expanding the transfer scale, and broadening the transfer scope. Moreover, our analysis of moderating factors reveals that the strength of the village collective economy positively moderates the relationship between organized land transfer and efficiency, whereas lineage networks exert a negative moderating influence. Addressing equity implications, this study also examines the model’s impact on farmers’ autonomy. The findings indicate that organized land transfer significantly suppresses transfer willingness, particularly in those with low incomes and the elderly. These results carry significant policy implications: when promoting organized land transfer, it is crucial to balance the strengthening of village collectives’ intermediary role with robust regulatory frameworks designed to safeguard farmers’ land rights and autonomy. Full article

Background: Vitamin D deficiency is a worldwide health problem associated with various health complications. This study aimed to determine the prevalence of vitamin D supplementation in the Czech Republic, understand reasons for supplementation, and assess participants’ knowledge of vitamin D’s physiological effects. Methods: The study included 1812 participants representing the Czech population aged 15+, stratified by gender, age, and regional distribution. Data analysis was performed using SASD 1.5.8, using chi² independence tests and regression analysis. Results: The results revealed that only 13.5% of the participants maintained regular year-round vitamin D supplementation, while 51.5% never supplemented. A slight increase in supplementation was observed during the pandemic (2020–2021). Supplementation patterns were influenced by socioeconomic factors including age, gender, marital status, income, employment, and education (p > 0.001). Regarding vitamin D knowledge, 67.5% and 65.6% of participants recognized its role in immune system modulation and bone health, respectively. There were minor misconceptions, with 1.4% believing that it aggravates allergies and 1.8% linking it to cancer. Knowledge levels varied with education and residence size. Conclusions: Despite the high prevalence of vitamin D deficiency in the Czech population, regular supplementation remains low, indicating the need for enhanced prevention programs and awareness campaigns. Full article