Search Results (217)

Western theories and empirical comparative research on attitudes toward immigrants and their rights have largely overlooked Latin America. To address this gap, we conducted multilevel ordered logistic regression analyses on Latinobarómetro surveys from 17 countries (N = 19,004). The findings show that support for immigrants’ social rights is more contingent on immigration-related benefits—especially cultural enrichment—than on perceived threats. When threats do mobilize opposition, the perceived fiscal burden emerges as the sole significant driver, overriding both concerns about labor market competition and fears of rising crime. Furthermore, right-wing individuals were no less supportive of immigrants’ social rights than left-wing individuals. Instead, the most welfare-chauvinist attitudes were found among the politically disengaged. At the macrosocial level, the results provide evidence that contextual factors not only exert a direct statistical effect on public support for immigrants’ social rights but also moderate the influence of perceived micro-level threats. In particular, the national unemployment rate and the immigrant stock exacerbate the exclusionary effect of the perceived fiscal burden on levels of support among citizens. Ultimately, these findings challenge some theoretical assumptions derived from intergroup threat theory, provide novel evidence for the Threat-Benefit Model, and further suggest a distinct political dynamic in the region. Full article

Objective: To identify demographic, clinical, and behavioural determinants of COVID-19 vaccination and antiviral uptake in Australia using the Capability, Opportunity, Motivation-Behaviour (COM-B) framework with psychometric validation and LASSO-enhanced variable selection. Methods: Cross-sectional analysis of the 2024 KAB BREATHE survey (n = 5177) of Australian adults, intentionally enriched for risk-stacked (more than 1 chronic condition). Primary outcomes included 2023/2024 COVID-19 booster receipt, future vaccine intentions, vaccine/antiviral beliefs and antiviral uptake. Predictors included demographics, chronic conditions, and domain-specific leave-one-out (LOO) COM-B scores standardised to mean = 0, SD = 1. COM-B domains were assessed using Cronbach’s alpha. Univariate and multivariable logistic regression models were complemented by LASSO penalised logistic regression with 10-fold cross-validation. Results: Among 5177 Australian adults, the mean age was 51.5 years (SD 16.5), 61.4% (3179/5177) were female, and 70.3% (3638/5177) were classified as risk-stacked. Booster uptake declined sharply from 50.8% (2023) to 19.1% (2024). Cronbach’s alpha showed poor internal consistency for Capability (α = 0.006) and Opportunity (α = −0.383) but was acceptable for full Motivation (α = 0.78). In adjusted models, age (aOR 1.02–1.03 per year), medically associated risk factors (aOR 1.66–3.51), and tertiary education (aOR 1.34–1.79) consistently predicted higher uptake and intention. Renting (aOR 0.59–0.78) and current employment (likely inversely associated with age) (aOR 0.73–0.83) were associated with lower uptake across all vaccine outcomes. Adding LOO COM-B scores substantially improved model fit (e.g., 2024 booster AUC 0.73→0.83); Motivation per SD was the strongest predictor (aOR 2.44–4.94 for vaccine outcomes, 1.52–2.49 for antivirals). LASSO models achieved CV-AUCs of 0.78–0.87. Among COVID-positive respondents (n = 2576), only 15.2% received antiviral treatment. Conclusions: Age, clinical risk, and socioeconomic factors, particularly housing tenure and employment status, are key drivers of COVID-19 preventive behaviours (either positively or negatively). The COM-B framework, when corrected for circular prediction and validated via Cronbach’s alpha and LASSO, provides substantial explanatory value. Targeted interventions should address structural barriers faced by renters and younger, employed individuals while leveraging high motivation among older adults and clinically vulnerable groups. Implications for Public Health: These findings support a shift from knowledge-based campaigns towards equity-focused, multi-level public health strategies that address structural barriers to COVID-19 vaccination and antiviral access in Australia. Full article

Generative artificial intelligence (GenAI) is rapidly reshaping higher education, yet barriers to its adoption across different disciplines and institutional roles remain underexplored. The existing literature frequently attributes adoption barriers to individual-level factors such as perceived usefulness and ease of use. This study instead investigates how such barriers are associated with structural conditions. Drawing on a multi-method survey analysis of 272 academic and professional service (PS) staff at Russell Group university, we examine how disciplinary contexts and institutional roles influence perceived barriers. By integrating multinomial logistic regression (MLR), structural equation modelling (SEM), and semantic clustering of open-ended responses, we move beyond descriptive accounts to develop a multi-level account of GenAI adoption. Our findings reveal patterned differences: non-STEM academics primarily report ethical and cultural barriers related to academic integrity, whereas STEM and PS staff disproportionately emphasize institutional, governance, and infrastructure constraints. We conclude that GenAI adoption barriers are deeply embedded in organizational ecosystems and epistemic norms, while also reflecting individual experiences and other unmeasured factors, suggesting that universities must move beyond generalized training to develop role-specific governance and support frameworks. Full article

This study examines how individual political predispositions and national mobilisation contexts jointly structure protest participation in contemporary Europe across the pre-pandemic, pandemic and post-pandemic periods. Using data from Rounds 9, 10 and 11 of the European Social Survey (2018–2023), the analytical sample includes 106,106 respondents from 33 countries. Descriptively, protest participation remains a minority behaviour, yet displays pronounced cross-national heterogeneity, with participation rates ranging from below 3% in several Central and Eastern European countries to nearly 20% in the most mobilised contexts and remains remarkably stable across rounds at approximately 8.5%. Building on resource mobilisation theory, political process approaches and New Social Movements perspectives, the analysis conceptualises protest participation not as an isolated behavioural act but as the outcome of interactions between individual resources, evaluative orientations toward democratic institutions and broader mobilisation environments. Logistic regression models, country fixed-effects specifications and multilevel models with random intercepts are used to assess these relationships. At the individual level, political engagement emerges as the strongest predictor of participation: higher political interest is associated with substantially higher protest propensity, while ideological self-placement indicates lower participation among respondents positioned further to the right. Younger age and higher education also increase participation. Lower satisfaction with democracy and stronger perceptions of inequality are consistently associated with protest behaviour, supporting grievance-based interpretations linked to democratic evaluations rather than material deprivation alone. Country fixed-effects and multilevel models confirm that these individual-level associations are robust within countries, while significant between-country variation persists (random-intercept SD = 0.554), indicating that national mobilisation environments shape baseline levels of protest participation. Multilevel results further reveal that protest participation was significantly lower during the pandemic period (Round 10) relative to the pre-pandemic baseline, with only partial recovery in the post-pandemic period. A cross-round comparison demonstrates that the core individual-level associations are stable across all three periods, indicating that these relationships reflect durable structural patterns rather than dynamics specific to any particular mobilisation cycle. Beyond this overall stability, the analysis identifies two theoretically informative exceptions: subjective financial difficulty is significant only in the pre-pandemic period and gender differences in protest participation attenuate over time—patterns consistent with broader shifts in protest repertoires during and after the pandemic. These findings make three contributions to the comparative literature on contentious politics. First, by extending the analysis across three ESS rounds, the study demonstrates the temporal robustness of individual-level determinants of protest—an empirical question rarely addressed in the existing literature. Second, the multilevel design with round fixed effects allows for direct estimation of pandemic-related suppression and post-pandemic recovery in protest activity at the aggregate level. Third, the cross-national scope and temporally structured comparison provide new evidence on how individual political predispositions interact with shifting mobilisation environments across a period of exceptional socio-political strain in Europe. Full article

Asthma is a chronic respiratory disease with uneven prevalence across population groups. This study investigated the associations between socioeconomic status, health behaviours, and environmental exposures and asthma prevalence across European countries. We conducted a cross-sectional analysis using data from the European Health Interview Survey (EHIS) covering wave III (2019). The sample included 223,453 adults aged 20 or older from 26 European countries. Asthma prevalence was self-reported. Socioeconomic variables included education and employment status, while behavioural factors included smoking and overweight status. Environmental exposures encompassed urbanisation and air pollution. Multilevel logistic regression models examined associations between asthma prevalence and its socioeconomic, behavioural, and environmental factors. Asthma prevalence was higher among individuals with lower educational attainment (OR = 1.30; 95% CI: 1.20–1.40), those who were unable to work due to long-standing health problems (OR = 2.27; 95% CI: 2.04–2.52), and retired individuals (1.44; 95% CI: 1.31–1.57). Individuals with pre-obesity and obesity had increased odds of asthma (OR = 1.13; 95%CI: 1.07–1.19, and OR = 1.76; 95%CI: 1.66–1.86, respectively). Urbanisation (OR = 1.13; 95%CI: 1.07–1.19) and exposure to air pollution (CO₂ and PM_2.5) were both significantly associated with higher asthma prevalence. Six countries exhibited a significant deviation from the average asthma prevalence. Inequalities in asthma prevalence in Europe were linked to socioeconomic disadvantage, unhealthy behaviours, and adverse environmental conditions. Some variability in asthma prevalence was independent of individual characteristics. These findings highlight the need for integrated public health policies that address the structural, behavioural, and environmental determinants of respiratory health. Full article

$Background$: In the grain logistics context, pre-processing operations such as reception, pre-cleaning, drying, storage, and shipping are performed at farm, collecting, intermediate, sub-terminal, and terminal storage units to preserve quality, reduce losses, and add value in the products. However, high transportation costs and limited static storage capacity reduce the selling prices. The objective of this article is to maximize profit associated with pre-processing, storage, and transportation along the grain flow in Brazil. $Methods$: A generic post-harvest logistics network is represented as a graph connecting producers, multi-level storage units, agribusiness facilities, and ports. A multi-period, multi-level mathematical model is applied in a case study framework explored in three scenarios, covering pre-cleaning, drying, storage, and transportation costs from production areas to commercialization nodes. $Results$: In all three scenarios, road transport resulted in transportation costs ranging from approximately US$ 49 million to US$ 492 million, mainly over long distances. $Conclusions$: The location and static capacity of collecting and intermediate storage units strongly influenced transport, storage use, CO₂ emissions, and post-harvest efficiency. Also, the flow concentration increased heavy-vehicle traffic, reducing overall logistics performance. Full article

Global supply chains face increasing vulnerability to disruptions from geopolitical tensions, natural disasters, and demand shocks. The global trade network for railway vans, critical for transcontinental freight transport, remains understudied despite its foundational role in global logistics. This study addresses the gap in understanding how the railway vans trade network structure evolves and responds to different types of shocks, moving beyond static analyses to capture dynamic vulnerabilities. Using UN Comtrade data (2013–2024), multi-level network analysis examined structural evolution at macroscopic, mesoscopic, and microscopic scales. Three risk propagation models simulated supply disruption, demand shock, and cooperation disruption scenarios to assess systemic vulnerabilities. The network transformed from a polycentric to core-periphery structure, with China dominating exports (67 partners in 2024) and Germany leading European integration. Supply disruptions from Romania and Czechia affected up to 114 countries under low risk absorption capacity (α = 0.1), while demand shocks from the USA impacted 53 countries. The disruption of strategic trade links, such as China–Australia, triggered severe systemic risks. The systemic criticality of risk sources varies by shock type, requiring context-specific resilience strategies. The findings guide policymakers in identifying critical vulnerabilities and designing targeted interventions for enhancing supply chain resilience in infrastructure sectors. Full article

While the association between food insecurity and adolescent obesity is well-established, the mechanisms through which these co-occurring public health crises are linked remain inadequately understood. Using the Social Ecological Model as a theoretical framework, this study examines how individual (physical activity), interpersonal (household food security), community (poverty level, residence), and societal (race/ethnicity) factors interact to influence adolescent weight outcomes. Cross-sectional data from 37,425 adolescents aged 12–17 years in the 2022–2023 National Survey of Children’s Health using weighted multinomial logistic regression with interaction terms were used. Adolescents experiencing nutrition insecurity (adequate quantity but poor-quality food) had 41% higher odds of obesity (adjusted odds ratio (aOR) = 1.41; 95% CI: 1.20–1.65), while those with food insecurity (insufficient quantity) had 48% higher odds (aOR = 1.48; 95% CI: 1.08–2.02) compared to food-secure peers. Significant effect modification emerged across ecological levels: poverty below the 200% federal poverty level (FPL) significantly amplified the food insecurity–obesity relationship (interaction p < 0.001), Hispanic and Black adolescents demonstrated 49% and 78% higher obesity odds, respectively, independent of household food and nutrition security status, and physical activity showed protective effects that varied by food security context (interaction p = 0.003). These findings underscore the necessity of multi-level interventions addressing structural inequities alongside individual behaviors to combat adolescent obesity in food-insecure populations effectively. Full article

The Turpan–Hami Basin, a critical energy hub in northwestern China, is plagued by frequent ground collapses induced by extensive mining over karst geology, threatening ecology and safety. Current hazard assessment methods, mainly single linear or traditional machine learning models, fail to capture the complex nonlinear interactions inherent to this coupled geo-mining environment. This study addresses this gap by establishing a multi-dimensional “Geology-Mining-Hydrology-Environment” index system comprising 14 critical factors—including lithology, goaf distribution, mining intensity, and their interaction terms. A coupled gradient boosting decision tree and logistic regression (GBDT-LR) model, optimized for the multi-factor coupling characteristics of ground collapse in arid mining basins, was applied for the hazard assessment. The results reveal a distinct spatial pattern of “core agglomeration with multi-level gradient differentiation.” Extremely high-hazard areas, covering 9.21% of the area, are concentrated in the core mining areas northwest of Turpan and southwest of Hami, while high-hazard areas (4.63%) form surrounding belts. The GBDT-LR model (AUC = 0.871) demonstrated significantly superior performance over a single logistic regression model (AUC = 0.813), proving its enhanced capability to identify high-hazard areas by modeling complex factor interactions. This work provides an essential scientific foundation for implementing zonal hazard management and prioritizing disaster prevention projects in key areas of the basin. Full article

Background: Drug-induced sleep endoscopy (DISE) with a jaw-thrust maneuver is used to simulate mandibular advancement in obstructive sleep apnea (OSA), yet determinants of functional airway improvement remain incompletely defined. Objective: To identify clinical, polysomnographic, and baseline DISE anatomic factors associated with jaw-thrust responsiveness. Methods: We conducted a single-center retrospective observational study of adults with polysomnography-confirmed OSA who underwent DISE with paired baseline and jaw-thrust VOTE assessments between 1 January 2015 and 31 December 2025 (n = 355). Jaw-thrust responsiveness was defined a priori as a within-subject reduction in the number of obstructed VOTE sites (grade ≥ 1). Multivariable logistic regression was used to identify independent correlates within a prespecified explanatory modeling framework. The study was approved by the Institutional Review Board of Taipei Tzu Chi Hospital (protocol 14-IRB079), with the need for informed consent being waived. Results: Jaw thrust reduced overall obstruction burden from two (two to three) to one (one to two) sites (Wilcoxon p < 0.001). Hypopharyngeal levels demonstrated the greatest improvement, particularly at the tongue base (39.2% to 7.6%) and epiglottis (23.9% to 5.4%) (both p < 0.001). Overall, 62.8% met responder criteria and 18.9% achieved complete normalization. In multivariable analysis (n = 272), baseline tongue-base collapse (adjusted odds ratio [aOR] 2.46, 95% CI 1.20–5.04) and greater baseline multilevel obstruction burden (aOR 1.85 per SD, 95% CI 1.19–2.85) were independently associated with responsiveness, whereas conventional PSG severity metrics were not. Conclusions: In adults with OSA, jaw-thrust responsiveness during DISE is more strongly associated with baseline anatomic phenotype than with global PSG severity. Standardized DISE functional assessment may provide complementary information to support phenotype-informed selection of non-CPAP therapies, pending prospective validation. Full article

Background: Elderly individuals are at high risk for pneumococcal pneumonia, and vaccination is crucial for prevention. This study aims to evaluate the effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPV23) in elderly individuals aged 65–84 years in Changshu City, identify key target groups, and explore potential factors influencing vaccine effectiveness. Methods: A multilevel cluster sampling method was employed to survey 2310 elderly individuals aged 65–84 years from four randomly selected towns/streets in Changshu City. Data were collected through face-to-face questionnaires and integrated with the immunization records system and electronic health records. Chi-square tests and multivariable logistic regression models were used to assess the association between PPV23 vaccination and pneumonia risk, with adjustments for potential confounding factors. Results: PPV23 vaccination significantly reduced the risk of pneumonia (adjusted OR = 0.69, 95% CI = 0.50–0.94, p = 0.019). The protective effect was more pronounced in individuals aged 75–79 years (OR = 0.56, 95% CI = 0.32–0.95) and females (OR = 0.48, 95% CI = 0.28–0.79). Chronic respiratory disease, survey location, gender, and age were identified as independent factors influencing vaccine effectiveness. Conclusions: PPV23 vaccination is effective in reducing pneumonia risk among elderly adults, particularly in specific subgroups. Future vaccination strategies should prioritize targeted programs for high-risk groups to improve coverage and effectiveness. Full article

Internal hospital logistics are inherently complex, characterized by the critical need to move essential materials with high efficiency, precision, and safety. The adoption of automated guided vehicles (AGVs) is essential for automating these flows, but designing and optimizing their routes represents a significant challenge. This study presents a methodology for analyzing and optimizing AGV paths within healthcare facilities, effectively managing three-dimensional spatial complexity. The methodology leverages BIM and the open IFC standard to obtain an accurate geometric and semantic representation of the building. These data are then converted into a graph model using graph theory. Pathfinding algorithms, such as A*, are applied to this graph to calculate and optimize AGV trajectories, considering operational and collision constraints. The approach provides distance-optimized AGV paths. The integration of BIM, IFC, and graph theory proves to be an effective tool for logistical planning, simulation, and proactive management of AGVs in multi-level environments. This research contributes to the digital transformation of the construction sector by demonstrating how the integration of open standards and advanced algorithms can optimize the operational performance of complex buildings. By bridging the gap between architectural modeling and robotic logistics, the proposed approach supports the development of “smart buildings” and promotes more sustainable and technologically advanced management of healthcare facilities. Full article

Background and Objectives: The volume–outcome relationship in congenital heart surgery (CHS) has been widely reported internationally, but systematic nationwide evidence from Korea remains limited. Given the concentration of high-volume centers in the Seoul Capital Area (SCA), we aimed to examine whether hospital surgical volume was associated with short-term mortality and to what extent regional disparities could be explained by differences in surgical volume. Materials and Methods: We conducted a nationwide retrospective cohort study of 31,150 patients who underwent CHS in 91 hospitals in Korea between 2002 and 2021 using National Health Insurance claims data. Hospitals were classified by location (SCA vs. non-SCA). Annual surgical volume was defined using two approaches, (i) above vs. below the overall mean annual volume (17.1 cases per hospital), and (ii) three categories (≤20, 21–40, and >40 cases/year). The primary outcome was 30-day mortality. Multivariable logistic regression adjusted for case mix, including J-STAT category, sex, hospital type, age, prematurity, and low birth weight. Hospital-level variation was further evaluated using generalized linear mixed models with random hospital intercepts, and intraclass correlation coefficients (ICCs) were estimated to quantify between-hospital variation and the explanatory contribution of surgical volume. Results: Overall 30-day mortality was 1.99%, with higher mortality observed in non-SCA hospitals compared with SCA hospitals (3.19% vs. 1.57%). After adjustment, lower annual surgical volume was strongly associated with higher 30-day mortality. Compared with hospitals performing >40 cases/year, the adjusted odds ratios were 4.13 (95% CI, 3.30–5.17) for hospitals performing 21–40 cases/year and 4.95 (95% CI, 3.98–5.95) for those performing ≤20 cases/year. In multilevel analyses, annual surgical volume accounted for 54% of the between-hospital variation in 30-day mortality. Adjustment for surgical volume substantially attenuated the regional disparity, with the odds ratio for non-SCA versus SCA hospitals decreasing from 2.12 (95% CI, 1.80–2.49) to 1.14 (95% CI, 0.95–1.37). Conclusions: A strong volume–outcome relationship exists in congenital heart surgery in Korea, with excess mortality concentrated in low-volume hospitals rather than regional location itself. Regional disparities in outcomes appear largely attributable to the uneven distribution of surgical volume. Strategies focused on service consolidation and strengthened referral to high-volume centers may be effective in reducing inter-hospital variation and improving national outcomes in pediatric cardiac surgery. Full article

Background: Improved pediatric cardiac care has markedly increased the adult congenital heart disease (ACHD) population worldwide, creating new clinical and healthcare delivery challenges. However, nationwide evidence on predictors of acute outcomes in ACHD patients, particularly the impact of disrupted specialist care under universal healthcare systems, remains limited. Methods: We conducted a retrospective analysis using Japan’s nationwide administrative database from 2013 to 2022, evaluating hospital admissions of ACHD patients aged ≥15 years. Patients were categorized into surgical, catheter-based, and medical treatment groups. Multilevel logistic regression models identified predictors of in-hospital mortality, including emergency and non-referral admissions as indicators of impaired continuity of specialist care. Results: A total of 27,754 admissions were analyzed (median age 59 years; 49% male). Emergency admissions accounted for 35.2%, non-referral admissions for 9.9%, and overall in-hospital mortality was 5.0%. Older age, admission to non-ACHD centers, higher CHD complexity, emergency admissions, and non-referral admissions were independently associated with increased mortality. In addition, older age, CHD complexity, and admission to non-ACHD centers predicted emergency and non-referral admissions. Conclusions: These findings show persistent gaps in specialist care continuity for ACHD patients despite universal healthcare coverage and support the need for integrated ACHD care networks to improve outcomes in this aging population in Japan. Full article

This study examines the perceived mental health of Ukrainian female forced migrants in Ireland through the lens of the socio-ecological model (SEM). Using binomial logistic regression on a 2023 online survey dataset (N = 656), it explores multi-level predictors across individual, relationship, community, and societal domains. Results indicate that individual-level factors explain the largest proportion of variance in perceived mental health (Nagelkerke R² = 0.399). Employment status, self-rated physical health, and coping strategies were key determinants: part-time employment and good physical health were associated with higher odds of good perceived mental health. In contrast, avoidant coping and worsening health were associated with poorer outcomes. Relationship-level factors (R² = 0.194) also contributed significantly; lack of social support and deteriorating family or friendship ties were linked to poorer mental health, whereas participation in refugee meetings was strongly protective. Community-level factors (R² = 0.123) revealed that unstable housing, living with strangers, and declining neighbourhood relationships were associated with reduced mental well-being. At the societal level (R² = 0.168), insufficient access to psychological support and excessive exposure to Ukrainian news were associated with poorer outcomes, while moderate news engagement was protective. The findings highlight the multifaceted nature of refugees’ perceived mental health, emphasising the interdependence of personal resilience, social connectedness, and systemic support. Full article