Search Results (1,429)

This study aimed to examine the relationship between post-traumatic stress symptoms following cryptocurrency loss and early maladaptive schemas in physicians. This cross-sectional study was conducted using a relational screening model and included 94 physicians across Türkiye who reported financial loss in cryptocurrency markets between 15 April and 15 July 2022. Data were collected online using a sociodemographic information form, the Young Schema Questionnaire–Short Form 3, and the Impact of Event Scale-Revised. Participants with an Impact of Event Scale–Revised total score of 33 or higher were classified as having elevated IES-R symptoms, reflecting elevated event-related distress according to a screening cutoff rather than a clinical diagnosis of PTSD. Eighteen participants (19.1%) were classified into this group. While no significant differences were found in age, marital status, employment status, or investment duration, the proportion of savings allocated to crypto was higher among participants with elevated IES-R symptoms. The elevated IES-R symptom group had higher scores in Failure, Pessimism, Dependence/Enmeshment, Punitiveness, Defectiveness, and Vulnerability to Harm, and additional correlation analyses showed that the IES-R total score was positively associated with Pessimism, Punitiveness, Dependence/Enmeshment, and Failure after false discovery rate correction. However, in the exploratory logistic regression analysis, none of these variables independently predicted elevated IES-R symptom status. These findings suggest that cryptocurrency loss may represent not only a financial stressor but also a significant experience associated with post-traumatic stress symptoms and maladaptive schema patterns in physicians. Full article

Background: Over the years, it has become increasingly clear that neurological conditions, such as multiple sclerosis (MS), commonly exhibit other health problems. Therefore, this is the first study aimed at investigating the prevalence of and factors associated with three binary outcomes: depression, anxiety, and an overactive bladder (OAB) among MS patients in the Qassim region, Saudi Arabia. Methods: This cross-sectional study was conducted in the neurological department of King Fahad Specialist Hospital in the Qassim region, Saudi Arabia, from January to December 2024. Data on age, sex, marital status, occupation, body mass index (BMI), MS duration, comorbidities, anxiety, depression, and OAB symptoms (frequency, nocturia, urgency, and urge incontinence) were obtained. Results: Of the 262 MS patients in this study, 184 (70.2%) were females, and 78 (29.8%) were males. The median values [IQR] of age and MS duration were 34 [26–40] and 5 [2–9] years, respectively. The prevalence of depression, anxiety, and OAB were 53.4%, 43.9%, and 50%, respectively. Nocturia was the most frequent urinary symptom, and urge incontinence was significantly higher among females. Multiple logistic regression analyses were conducted to assess factors associated with three binary outcomes: depression, anxiety, and OAB. For depression, being single and anxiety were associated with increased risk. Regarding anxiety, being a student was related to decreased risk, while being female and having depression were associated with increased risk. For OAB, only anxiety was associated with increased risk. Conclusions: Approximately one in two MS patients experience either depression or OAB, while anxiety was reported by fewer than half of the patients. This high prevalence of the three outcomes has critical implications for healthcare policy and resource allocation. Thus, screening, early diagnosis, and intervention, as well as integrated care, should be prioritized by healthcare institutions and practitioners to address these conditions and improve MS patients’ quality of life. Full article

Background: Psychological distress (PD) has been associated with lifestyle behaviors, including physical activity, sleep duration, and diet-related practices. Dietary self-efficacy may represent a self-regulatory correlate in these relationships; however, evidence from population studies remains limited, particularly in Peruvian adults. Objective: To examine whether dietary self-efficacy is statistically associated with the links between physical activity, sleep duration, vegetarian status, and PD in a sample of Peruvian adults. Methods: A cross-sectional study was conducted in 684 Peruvian adults. Structural equation modeling (SEM) was used to evaluate the proposed associations, adjusting for age, sex, educational level, marital status, residence, and BMI. Results: The SEM showed acceptable fit, with RMSEA and SRMR within recommended ranges and CFI/TLI slightly below 0.90 (CFI = 0.898, TLI = 0.886, RMSEA = 0.039, SRMR = 0.047). Lower dietary self-efficacy was associated with higher PD (β = 0.283, p < 0.001). Physical activity showed an indirect statistical association with lower PD via dietary self-efficacy (β = −0.043, p < 0.001) and a significant total association with PD (β = −0.085, p = 0.018). Sleep duration showed a curvilinear (U-shaped) association with PD (linear β = −0.122, p = 0.001; quadratic β = 0.124, p < 0.001), but not via dietary self-efficacy. Vegetarian status was not directly associated with PD (β = 0.002, p = 0.956), and its indirect statistical association via dietary self-efficacy did not reach conventional significance (β = 0.022, p = 0.070). The model explained 14.1% of the variance in dietary self-efficacy and 19.3% of the variance in PD. Conclusions: Lower dietary self-efficacy was associated with higher PD and captured a model-based indirect statistical association between physical activity and PD. Given the cross-sectional design, these findings should be interpreted as correlational and warrant confirmation in longitudinal or experimental studies. Full article

Generative artificial intelligence (GAI) is increasingly embedded in personal finance, yet little is known about how models make recommendations using financial information and demographic cues. This study audits three frontier GAI models, GPT 5.5, Gemini 3.1 Pro, and Claude Opus 4.7, using a conjoint experiment in which each model evaluated the same hypothetical investor profiles and selected among standardized conservative, balanced, and aggressive portfolios. Investor profiles systematically varied attributes, including risk tolerance, time horizon, goal type, income, and age, gender, ethnicity, marital status, and employment type. Ordered logistic regressions and matched-profile comparisons show that all three models base recommendations primarily on financial attributes, especially risk tolerance and time horizon. Age and marital status shift recommendations towards conservatism in all models, conversely only Claude conditions on gender and employment type. Ethnicity exerts no detectable influence on the recommendations of ChatGPT or Claude, but is a small, statistically significant predictor for Gemini, with non-White profiles receiving slightly more conservative recommendations than otherwise identical White profiles. Overall, we find that the models are not interchangeable: they differ significantly in overall risk appetite and in how they translate risk tolerance, time horizon, goal type, and age into portfolio choices, with economically meaningful differences in predicted recommendations for identical clients. These findings suggest that contemporary GAI investment advice is driven mainly by financially relevant attributes, but that demographic sensitivity may appear in model-specific and statistically nuanced ways, alongside a distinct form of platform risk arising from model-specific advisory logic. Full article

Background/Objectives: Parents of children with autism spectrum disorder (ASD) often face sustained emotional, practical, and social demands. However, evidence from Romania remains limited, particularly regarding the combined assessment of caregiver burden, emotional distress, and coping strategies of parents. This exploratory study compared these outcomes between parents of children/adolescents with ASD and parents of typically developing children and examined whether coping patterns varied according to selected sociodemographic characteristics. Methods: We conducted a cross-sectional comparative study in Târgu-Mureș, Romania, between 2024 and 2025. The sample included 92 parents: 46 parents of children/adolescents with clinician-confirmed ASD and 46 parents of typically developing children. Participants completed a demographic questionnaire, the Caregiver Burden Inventory (CBI), the Depression Anxiety Stress Scales-21 (DASS-21), and the Strategic Approach to Coping Scale (SACS). DASS-21 data were available for 44 ASD caregivers and 46 controls. Between-group comparisons were performed using t-tests, Mann–Whitney U tests, chi-square tests, or Fisher’s exact tests, as appropriate. Results: The groups were comparable in sex, age, residence, number of children, and household size, but differed significantly in marital status and educational level. Clinically relevant caregiver burden (CBI ≥ 36) was more frequent among parents of children with ASD than among controls (30% vs. 17%), although this difference was not statistically significant. Parents of children with ASD showed trend-level higher depressive and anxiety symptoms, with small effect sizes, whereas stress scores were similar between groups. Coping patterns varied according to sociodemographic characteristics. Marital status was associated with aggressive coping, urban residence was associated with indirect and aggressive coping, and number of children was associated with seeking social support. Conclusions: Parents of children with ASD showed a higher proportion of clinically relevant caregiver burden and trend-level elevations in depressive and anxiety symptoms, while stress scores were comparable between groups. Exploratory adjusted analyses suggested that ASD caregiver status remained associated with caregiver burden and depressive symptoms after controlling for educational level and marital status. Coping strategies appeared heterogeneous and context-dependent. Given the exploratory design, modest sample size, and multiple comparisons, these findings should be interpreted as preliminary and hypothesis-generating. Full article

Objective: This study aimed to assess health-related quality of life (HRQoL) among postpartum women in Jordan and identify the factors that may influence it. Methodology: This study employed a cross-sectional design and was conducted among women who had given birth within the last year, selected through cluster randomization from four primary healthcare centers in Amman. Household resource quality of life was measured on the validated 36-Item Short Form Survey (SF-36), which covers eight domains of health. Descriptive statistics were calculated. Independent t-tests and one-way ANOVA were used to compare mean HRQoL scores across categories of socio-demographic variables (e.g., marital status, income, employment, feeding type). Pearson correlation was used to examine the relationship between age (the only continuous variable) and HRQoL domains. Statistical significance was set at p < 0.05. Results: The physical functioning had the highest HRQoL (62.48 ± 25.19), and the lowest HRQoL (34.59 ± 37.46) was found in role limitations due to physical health and emotional problems (36.37 ± 40.90). Key socio-demographic factors were highly related to HRQoL. Better general health perceptions (p = 0.003) and emotional well-being (p = 0.005) were found to be correlated with higher income. The married women scored much higher in physical functioning (p = 0.015) and emotional well-being (p = 0.013) than divorced women. Infant feeding methods and employment status were also significantly associated with certain domains of HRQoL. Conclusions: Postpartum women in Jordan experience low HRQoL, particularly in the domains related to role limitations. Socio-demographic factors were found to be crucial, wherein marital status and income are specific aspects. This study strongly recommends immediate integration of an appropriate multidimensional support program in postpartum care as an intervention toward improving maternal well-being. Full article

Health literacy (HL) is an important factor associated with individuals’ capacity to manage their health effectively. This cross-sectional study assessed HL and its associated factors among 327 community-dwelling individuals in Northern Thailand. Data were collected through face-to-face interviews using the 47-item European Health Literacy Questionnaire (HLS-EU-Q47). The participants were predominantly female (59.9%), with a mean age of 59.0 ± 11.7 years. Overall, 60.2% of the participants exhibited problematic HL across all domains. In bivariate analyses, overall HL was significantly associated with sex, age, body mass index (BMI), education, marital status, and hypertension. Age was negatively correlated with overall HL (r = −0.250, p < 0.001), whereas BMI was positively correlated with overall HL (r = 0.130, p = 0.019). In the multivariable linear regression model, higher education (β = 4.251, p < 0.001), female sex (β = 2.310, p = 0.002), and alcohol consumption (β = 1.411, p = 0.047) were independently associated with higher HL scores. Conversely, marital status (β = −1.747, p = 0.033) was associated with lower HL scores. Problematic HL was highly prevalent in this population and was associated with sociodemographic and health-related factors. These findings highlight the need for targeted, context-specific health communication and education strategies to improve HL among vulnerable community-dwelling populations, particularly older adults and individuals with lower educational attainment. Full article

Accurate prediction of loan defaults is essential for financial institutions seeking to minimize credit losses and maintain portfolio stability. In the vehicle financing segment of emerging markets, real-world datasets frequently exhibit extreme class imbalance ratios that far exceed those encountered in standard benchmark corpora, posing severe challenges for conventional machine learning pipelines. This study introduces a gradient boosting framework integrating Weight of Evidence (WoE) transformation, Bayesian hyperparameter optimization, and three complementary classifiers—Extreme Gradient Boosting (XGBoost), Light Gradient Boosting Machine (LightGBM), and Categorical Boosting (CatBoost)—to predict vehicle loan default risk. The methodology is evaluated on a large-scale, fully anonymized Turkish vehicle loan dataset ($N=207,572$) with an extreme imbalance ratio of 1:1133 (183 defaults versus 207,389 non-defaults). A strict three-way data partition (60% training, 20% validation, 20% test) is adopted to ensure leakage-free model selection and unbiased performance estimation. A multi-stage experimental pipeline is developed encompassing: (i) statistical feature selection via Mann–Whitney U and chi-square tests with adaptive thresholding, (ii) a comparative analysis of seven resampling strategies including Synthetic Minority Oversampling Technique (SMOTE) variants, Adaptive Synthetic Sampling (ADASYN), and focal loss weighting, (iii) a greedy forward selection ensemble procedure for heterogeneous model fusion, and (iv) a systematic training-set size sensitivity analysis across eight majority undersampling ratios. Under the leakage-free evaluation protocol, the highest-AUC individual model (LightGBM with SMOTE-ENN) achieves an Area Under the Curve (AUC) Receiver Operating Characteristic (ROC) of 0.710 (95% bootstrap CI: 0.614–0.798), while CatBoost with cost-sensitive weighting exhibits superior operational metrics (KS $=0.389$, PR-AUC $=0.011$). The greedy ensemble procedure exhibits high selection instability with only 37 validation-set positives, providing a methodological finding on the minimum sample requirements for reliable ensemble construction under extreme scarcity. Ablation results confirm that WoE encoding contributes 3.1 percentage points to the overall AUC gain. Tree SHAP-based interpretability analysis identifies the financing-to-age ratio, WoE-encoded occupation group, and log financing amount as the primary predictive drivers, with cross-model stability confirmed via Spearman rank correlation. A decision support analysis provides precision–recall curves, a Brier score of 0.0082, reliability diagrams, and threshold-dependent performance at operationally plausible review rates. Fairness evaluation across gender and marital status subgroups demonstrates that threshold-dependent metrics such as Disparate Impact Ratio and Equalized Odds Gap are inherently compromised under extreme minority scarcity, whereas rank-based subgroup AUC analysis with bootstrap 95% confidence intervals preserves meaningful discriminative assessment. These findings provide an empirically validated framework for credit default prediction in highly imbalanced and data-scarce financial environments. Full article

This article examines how Confucianism becomes religionized through ritual performance in Korean mask dance drama (gamyeon-geuk), focusing on Hahoe Byeolsingut Talnori and Bongsan Talchum. It argues that these performances should not be understood only as folk entertainment or carnivalesque satire, but as ritualized forms that mediate divine and ancestral witnessing, communal publicity, and gendered moral evaluation. Within this ritual horizon, laughter, music, embodied movement, masks, props, and stage choreography distribute authority, visibility, speaking positions, and standards of judgment. Methodologically, the study employs multimodal critical discourse analysis of contemporary full-length performance recordings, treating language, movement, staging, costume, props, and audience response as an integrated semiotic field. Across both repertoires, female figures are repeatedly configured as silent or constrained speaking subjects, as visible carriers of moral disorder, or as expendable intermediaries within marital and status hierarchies, while male characters more consistently occupy positions of interpretation, judgment, and ritual agency. By foregrounding ritualized spectatorship as a process of moral common-sense production, the article contributes to debates on Confucianism as lived religion and shows how performance can stage critique while reauthorizing Confucian patriarchal order. Full article

Background/Objectives: The POLA index is a comprehensive tool for evaluating the nutrient-dense, immune-supportive, and anti-inflammatory properties of the diet, but its multi-component structure may limit routine use. We aimed to identify simple dietary markers associated with a lower follow-up incidence of COVID-19 or influenza, as well as the anti-inflammatory properties of the diet, and to compare a simplified screening tool with the full POLA index. Methods: This prospective observational study included 146 healthy adults aged 25–45 years from two Polish cohorts examined in 2020 and 2022 (cohort/year adjusted). Habitual diet was assessed using at least 5-day food records, and nutrient adequacy was expressed relative to Polish dietary reference values. Classification and regression tree analyses were used to identify the most informative dietary predictors of the reduction in risk of infection, and logistic regression models were used to evaluate associations after adjustment for sex, diet type, physical activity, marital status, year of cohort and waist-to-height ratio. Results: During follow-up, 39/146 participants (26.7%) reported COVID-19 or influenza. Interactive tree analysis identified dietary fiber in g per kg/m² of BMI ≥ 1, and magnesium adequacy as the key discriminators. In StrongPOLA, participants not meeting the cut-offs of ≥1 g fiber per kg/m² of BMI and ≥130% of the magnesium reference value had a higher incidence of COVID-19 or influenza than those meeting both of those cut-offs (34.9% vs. 2.7%); however, this estimate was large and imprecise, with a wide confidence interval (the adjusted OR = 14.9 (95% CI: 1.89–118.06)), and should, therefore, be interpreted cautiously. In RapidPOLA, the participants not meeting the cut-offs of ≥1 g fiber per kg/m² of BMI and ≥110% of the magnesium reference value (i.e., 352 mg/day for women and 462 mg/day for men) had a higher observed incidence of COVID-19 or influenza than those meeting both of those cut-offs (36.4% vs. 12.1%); the adjusted OR was 3.4 (95% CI: 1.18–8.75). RapidPOLA showed good agreement with the favorable result of the POLA classification (κ = 0.65). Conclusions: Dietary fiber in g per kg/m² of BMI and magnesium adequacy appear to be practical markers of a broader nutrient-dense, immune-supporting, and anti-inflammatory dietary pattern associated with a lower follow-up incidence of COVID-19 or influenza in young adults without comorbidities. RapidPOLA may be useful as a simple screening tool for a nutrient-dense, immune-supportive, and anti-inflammatory (NUTRIDIMAF) diet in young people without obesity and comorbidities, whereas StrongPOLA may serve as a stricter reference profile. The proposed cut-offs require external validation in independent and more diverse cohorts. Full article

Introduction: The work-related quality of life affects employee satisfaction and organizational effectiveness, with a direct impact on the quality of healthcare. This study aims to investigate the work-related quality of life (WRQoL) among nurses in tertiary healthcare, as perceived by the nurses themselves, in relation to their demographic and professional characteristics. At the same time, it seeks to highlight the way in which the individual dimensions of WRQoL influence their sexual and mental health. Materials and Methods: A descriptive cross-sectional study was conducted in 2023 in a General Hospital in Greece. Data were collected using structured questionnaires assessing sociodemo-graphic and occupational characteristics, WRQoL, mental health (Depression, Anxiety and Stress Scale—DASS-21), and female sexual function (Female Sexual Function Index—FSFI-19). Pearson correlation analysis and multiple linear regression analysis were performed. The regression model was adjusted for age, marital status, number of children, and work experience. Results: The results demonstrated a significant negative association between depression and sexual function (β = −0.388, p = 0.029), while stress was positively associated with sexual function (β = 0.371, p = 0.038). The overall regression model was statistically significant (p = 0.001), explaining 18.6% of the variance in sexual function. Conclusions: The findings highlight the close interrelationship between work-related quality of life, mental health, and sexual function among nurses. Poorer psychological well-being was associated with reduced sexual function, emphasizing the impact of occupational and emotional burden on nurses’ overall health. These results underline the importance of supportive workplace environments and targeted interventions to promote mental and sexual well-being among healthcare professionals. Full article

Background: Shift-working healthcare workers (HCWs) are at elevated cardiovascular (CV) risk due to chronic circadian disruption; however, gender-stratified data on CV risk profiles and modifiable risk factor distribution by occupational exposure duration remain scarce in the Italian hospital setting. This cross-sectional study aimed to characterise the 10-year CV risk profile and the distribution of modifiable risk factors in a hospital-based sample of shift-working HCWs. Methods: A retrospective cross-sectional study was conducted using data from routine occupational health surveillance of shift-working HCWs at a large Italian hospital in Salento, Southern Italy (survey year: 2025). The 10-year CV risk was estimated using the CUORE Project algorithm, validated for the Italian population. Risk was stratified by gender, age group, and shift work duration. Multivariable logistic regression models, adjusted for age, marital status, and presence of children at home, evaluated associations between selected risk factors and CV risk category. The study was reported in accordance with STROBE guidelines. Results: Of 765 HCWs included (320 males, 445 females; mean age 49.3 ± 8.5 years), male workers showed a significantly higher mean 10-year CV risk score (4.98 ± 2.8 vs. 1.34 ± 0.9; p < 0.05). Among male workers, the odds of moderate/high CV risk increased progressively with shift work duration (aOR 6.4 for >30 years). Males also showed significantly higher prevalence of arterial hypertension, overweight, and obesity across all strata. Conclusions: Male shift-working HCWs represent a higher-risk subgroup, characterised by a greater burden of modifiable cardiovascular risk factors. Integration of validated risk assessment tools into occupational health surveillance may support targeted preventive strategies in hospital settings. Full article

Climate change continues to threaten global food security. Climate-smart agriculture (CSA) offers a solution to addressing this challenge in urban agriculture (UA). This paper addresses a gap in the empirical literature on decision-making about the adoption of CSA practices by examining the determinants of CSA adoption among small-scale urban crop (SSUC) farmers in eThekwini (ETH) Municipality, South Africa. Grounded in a utility theory framework, the paper draws on 412 respondents (Cochran-estimated) from a multi-stage sample design across four wards, providing reasonable coverage of SSUC farmers in ETH Municipality. While the sample size is statistically representative of SSUC farmers in ETH Municipality, it is a single metropolitan case rather than universal. The results show strong complementarities among these CSA practices, for example, between OM and CD (r ≈ 0.70, p < 0.001) and M and CD (r ≈ 0.61, p < 0.001). The multivariate probit (MVP) model predicts that the socio-economic and institutional factors age, gender, marital and employment status, education, credit access, extension contact, land tenure, and location (distance from home to farm plots) (p < 0.05) were significant determinants of adopting CSA practices by SSUC farmers. The findings contribute to the global literature on the UA–CSA nexus, demonstrating that socio-economic and institutional factors shape the adoption of bundled CSA practices. While the findings underscore the need for integrated, custom, and UA context-specific policy and extension interventions to strengthen urban food system resilience, UA farmers, practitioners, researchers, and policymakers should apply these insights elsewhere with caution. Full article

Background/Objective: Kinesiophobia is a major fear-avoidance concept in chronic low back pain (CLBP); however, its independent contribution to pain, disability, and health-related quality of life (HRQoL) beyond sociodemographic and clinical variables remains unclear. This study aimed to evaluate the associations between kinesiophobia and patient-reported outcomes in adults with chronic low back pain regarding (i) pain intensity, (ii) functional disability, and (iii) HRQoL. Methods: This cross-sectional study included 298 participants with CLBP (average age 38.7 ± 13.2 years; 58.0% female). Kinesiophobia was evaluated using the Tampa Scale of Kinesiophobia (range, 17–68). Outcomes were pain intensity (Numerical Pain Rating Scale; 0–10), functional disability (Roland–Morris Disability Questionnaire; 0–24), and HRQoL (RAND-36; 0–100). Two multivariable linear regression models were used per outcome. Model 1 was adjusted for sex and age, and Model 2 was additionally adjusted for BMI, marital status, education, employment, smoking status, and chronic disease. Hierarchical regression analysis evaluated the incremental variance explained by kinesiophobia (ΔR²) when entered after all covariates. Effects were reported per 10-point increase in Tampa score, with 95% confidence intervals (CI). Results: In the fully adjusted models, higher kinesiophobia was associated with greater pain intensity (B = +1.17 points per 10 Tampa; 95% CI 0.55–1.79, p < 0.001), greater disability (B = +3.24 points; 95% CI 2.05–4.43; p < 0.001), and lower HRQoL (B = −7.98 points; 95% CI −11.1–−4.81; p < 0.001). Hierarchical regression analyses showed that kinesiophobia explained additional variance in pain (ΔR² = 0.11), disability (0.12), and HRQoL (0.11), all p < 0.001. Conclusions: In adults with CLBP, kinesiophobia was associated with greater pain intensity, functional disability, and lower HRQoL, accounting for 11–12% of variance in each outcome beyond demographic and clinical covariates. These findings support routine assessment of kinesiophobia and justify longitudinal and interventional studies to determine temporal relationships and treatment effects. Full article

Food insecurity has been associated with poorer diet quality; however, limited evidence exists on the association between food insecurity and adherence to the Mediterranean diet in Saudi Arabia. This cross-sectional study, conducted among 577 Saudi adults between February and June 2025, examined the association between food security status and adherence to the Mediterranean diet in this region. Data were collected through a self-administered questionnaire that included sociodemographic characteristics, the Food Insecurity Experience Scale, and the Mediterranean diet adherence score. Most participants were food secure (73.0%), and only 12.7% demonstrated high adherence to the Mediterranean diet. The food insecurity score was inversely related to Mediterranean diet adherence (B = −0.107, 95% CI −0.191 to −0.024; p = 0.012); however, the magnitude of the association was small. Age, marital status, and monthly income were also significantly associated with food security status (p < 0.005). Although most of the participants were food secure, overall adherence to the Mediterranean diet was low, with only a small proportion demonstrating high adherence. These findings suggest that socioeconomic factors, particularly income, may be associated with both food access and diet quality. Further research is needed to inform strategies aimed at improving access to affordable healthy foods and promoting healthier dietary patterns, especially among young adults and low-income individuals. Full article