Search Results (322)

Based on a literature review, the present article aims to present ecotourism as a transformative factor in the economic, social, cultural, and environmental contexts, revealing key elements for the sustainable development of ecotourism. To ensure that this objective is met, the review combines the insights of classical authors and many recent authors who have best addressed the subject. The review carefully selected consensual and contradictory arguments, reflecting on the relevance of each group, particularly in aspects such as the influence of emotional experience on behaviour and satisfaction, strategy and competitive advantage, cooperation and sustainability, and the influence of resilience on ecotourism. The impact of each perspective was presented without ignoring the major constraints that ecotourism faces in its search for a position in the tourism industry. This led the study to accept the fact that the active participation of the community is indispensable in the formula for the success of ecotourism. Some statistical data were consulted and analysed, which enabled the study to determine the quantitative impact of ecotourism on economic, social, and environmental life. In terms of benefits to communities, the review clarifies the fact that ecotourism serves as an instrument that mobilizes not only the additional value of products and services traded in the process, but also the return on investments and job creation. The combination of visiting activities with the involvement of tour guides contributes to maximizing profits in the destinations, thus supporting solid economic, social, and environmental development for the benefit of both ecotourism promoters and local communities. However, the analysis makes it clear that the economic, social, and environmental benefit depends on the degree of involvement of the local population. In terms of usability, for other studies, this review can contribute to the understanding and positioning of ecotourism in the search for a balance between satisfying socioeconomic and environmental interests. Additionally, it can serve as an aid to policy makers in their decisions related to ecotourism. Full article

Background: Iron deficiency anemia (IDA) represents a significant public health concern, particularly among female populations. Various demographic factors, including age and socioeconomic status, have a substantial impact on overall health outcomes, contributing to the prevalence of IDA. The primary objective of this study was to assess the knowledge and awareness of iron deficiency anemia among the adult population and to examine its correlation with various sociodemographic factors. Methods: A cross-sectional study was conducted in the Northern Region of Saudi Arabia between October and December 2024. Data were collected using a structured questionnaire from 385 participants aged 18 years and older. The Chi-square test was utilized to assess the association between categorical variables. Results: In this study, 42.5% of participants demonstrated good knowledge of IDA, 48.1% had moderate knowledge, and 9.4% showed poor knowledge. Knowledge levels were significantly associated with gender, age, education, and self-perceived IDA status. Women, older individuals, and those with higher levels of education had a greater knowledge of IDA. Regarding attitude, 93% of participants had a positive attitude, while only 7% exhibited a negative attitude. Interestingly, none of the explanatory variables were significantly linked to attitude, suggesting that positive attitude toward IDA was consistent across all demographic groups. Conclusions: This study highlights the need for targeted health initiatives focusing on diet, supplementation, symptom recognition, and prevention to effectively reduce the burden of IDA. Prioritizing education through symposiums and medical programs in high-prevalence regions is crucial. Full article

Background: Childhood hearing loss is a public health problem of critical importance associated with speech development, academic achievement, and quality of life. Parents’ awareness and knowledge about risk factors contribute to early detection and timely intervention.  Objective: This study aims to examine Jordanian mothers’ knowledge of childhood hearing loss risk factors and investigate the impact of education level and socioeconomic status (SES) on the accuracy and comprehensiveness of this knowledge with the moderating effect of health literacy. Material and Methods: The approach employed an embedded mixed-methods design with a dominant quantitative strand supported by qualitative data, utilizing quantitative surveys (n = 250), analyzed using structural equation modeling (SEM) in SmartPLS, and qualitative interviews (n = 10), analyzed thematically to expand upon the quantitative findings by exploring barriers to awareness and healthcare-seeking behaviors. Results: The accuracy and comprehensiveness of knowledge of hearing loss risk factors were also positively influenced by maternal knowledge of hearing loss risk factors. Maternal knowledge was significantly associated with both education level and socioeconomic status (SES). Furthermore, maternal knowledge and accuracy were significantly moderated by health literacy, such that mothers with higher health literacy exhibited a stronger relationship between knowledge and accuracy. Qualitative findings revealed that individuals encountered barriers to accessing reliable information and comprehending medical advice and faced financial difficulties due to limited options for healthcare services. Conclusions: These results underscore the need for maternal education programs that address specific issues, provide simplified healthcare communication, and enhance access to pediatric audiology services. Future research should explore longitudinal assessments and intervention-based strategies to enhance mothers’ awareness and detect early childhood hearing loss. Full article

Traditional villages are critical to preserving cultural heritage and promoting sustainable rural development. This study evaluates the development potential of 47 traditional villages in Jilin Province from the perspectives of spatial planning, architectural conservation, and rural real estate revitalization. A Development Potential Assessment (DPA) framework is constructed based on five dimensions: geographical position, cultural resources, socio-economic factors, natural ecology, and living environment. The AHP-entropy weighting method is applied to ensure objectivity in scoring, while kernel density analysis and coefficient of variation techniques identify spatial patterns and internal disparities. To further inform strategic planning and targeted investment, an Importance–Performance Analysis (IPA) model is introduced, aligning resource advantages with development performance. Key findings include the following: (1) significant spatial heterogeneity, with higher potential concentrated in the southeast and lower levels in the northwest; (2) cultural and socio-economic dimensions are the most influential factors in differentiating development types; and (3) a subset of villages shows a disconnect between resource endowment and realized potential, indicating the need for tailored design interventions and investment strategies. This research offers a visual and data-driven basis for differentiated revitalization strategies, integrating urban science methods, architectural thinking, and real estate development logic. It supports refined policy implementation, spatial design decisions, and the activation of underutilized rural assets through context-sensitive planning. Full article

Background/Objectives: Despite its well-established health benefits, adherence to the Mediterranean lifestyle (MedLife) has declined globally, including in its region of origin, alongside a significant shift toward ultra-processed food consumption. Understanding the factors associated with MedLife adherence is essential for developing targeted interventions and tailored policy recommendations. As part of the MEDIET4ALL PRIMA project, this cross-sectional study aimed to comprehensively examine geo-demographic, socio-economic, psychological, behavioral, and barrier-related factors associated with and potentially contributing to MedLife adherence. Methods: Data were collected from 4010 participants aged 18 years and above across ten Mediterranean and neighboring countries using the multinational MEDIET4ALL e-survey, which included the validated MedLife index, along with various other questionnaires. Results: Results indicate that only 22% of respondents demonstrated high adherence to the Mediterranean lifestyle (MedLife), with significant variability observed across countries, age groups, education levels, and health statuses. Spain had the highest proportion of participants with high adherence (38%). Factors associated with significantly higher adherence rates include older age, living in the Mediterranean region, higher education levels, a greater awareness of MedLife principles, lower perceived barriers, normal BMI, better health status, and stable economic and marital conditions (p-values ranging from 0.04 to <0.001). Additionally, individuals with high MedLife adherence exhibited more socially and physically active lifestyles and experienced less psychological strain (p < 0.001). Regression analyses identified MedLife awareness as the strongest positive predictor of adherence (β = 0.206), followed by social participation (β = 0.194) and physical activity (β = 0.096). Additional positive contributors include life satisfaction, sleep quality, living in the Mediterranean region, age, and education (β ranging from 0.049 to 0.093). Conversely, factors that are negatively associated with adherence include sedentary behavior, living environment, and barriers such as low motivation, taste dislike, price unaffordability, limited availability, and the time-consuming nature of preparing Mediterranean food (MedFood; β ranging from −0.036 to −0.067). Conclusions: These findings indicate that fewer than one in four adults across Mediterranean and neighboring countries demonstrate high adherence to MedLife, supporting prior evidence of suboptimal adherence even within Mediterranean regions. This study identified a range of behavioral, socio-demographic, and environmental factors—both positive and negative predictors—that can help guide the design of targeted, culturally adapted interventions to promote MedLife behavior. Future research should incorporate objective measurements and longitudinal monitoring to better understand underlying mechanisms, establish causality, and develop sustainable strategies for enhancing MedLife adherence in diverse populations. Full article

Carbon emission forecasting is a critical step in addressing climate change and effective environmental management. However, previous studies have concentrated mainly on socioeconomic factors, with less attention directed toward the significant impact of urban form. To address the shortcomings of previous studies, this study introduced three types of landscape indices that can characterize urban form and combined them with conventional socioeconomic factors to create a new carbon emission forecasting method. The enhanced STIRPAT and PLUS models were employed to forecast future changes in various socioeconomic factors and urban form, with the aim of forecasting carbon emissions in 21 cities of Guangdong during 2025–2060. The results confirm that urban form has an obvious influence on carbon emissions. In comparison to the baseline model, which considered only socioeconomic factors, the incorporation of urban form into the carbon emission forecast resulted in a reduction in the mean absolute percentage error from 7.16% to 6.18%. Moreover, carbon emissions were found to be positively correlated with GDP per capita, energy intensity, permanent population, share of secondary sector, LSI, and PLADJ but negatively correlated with PD. Furthermore, Guangdong will not be able to accomplish its “carbon peaking” objective around 2030, except in a low-carbon situation. Our proposed method could enhance the rationality of carbon emission forecasting, thereby providing a reasonable decision-making basis for low-carbon management. Full article

Women disproportionately encounter negative affordances in urban environments—defined as features that severely restrict movement and impose harm. City venues are, thus, selectively permeable to women, though men face their own challenges, especially in intersectional contexts. The data in this study suggest that gender combines with ethnicity, socioeconomic status, and visible religious markers, making obstruction a shifting but nonetheless real phenomenon, much like a staircase genuinely impedes wheelchair access. Cultural context also matters: a Black woman may face one set of barriers in Paris, another in Seoul, with a Latin American woman encountering different ones in both. Building on these observations, the article argues that urban landscapes manifest gender-based political affordances—material configurations that reflect and reinforce social inequalities. As an affordance-based framework, the selective permeability model (1) draws on a well-supported theory of perception, where settings objectively present both favorable and hostile values relative to agents. The outlook (2) thereby challenges the stereotype that women’s spatial concerns are merely subjective. The position also (3) affirms that despite differences, people share bodily constraints and, hence, have largely overlapping values and experiences. The perspective accordingly avoids exaggerating divisions to the point of denying the mutual understanding that underlies empathetic norms. Full article

Background: The global rise in life expectancy and the resulting shift toward ageing populations pose significant public health and socioeconomic challenges. As healthy ageing becomes a priority, understanding the factors that support well-being in older age is essential. Oral health is increasingly recognised as a critical determinant of overall health and has been linked to chronic conditions. Objectives: To conduct a systematic review of longitudinal studies examining the relationship between oral health and healthy ageing. Materials and Methods: Two independent reviewers conducted searches in three databases (MEDLINE, EMBASE, and LILACS) up to April 2025, following a defined search strategy. Grey literature was explored using Open Grey and Google Scholar. The quality and the risk of bias of the included studies were evaluated using the Newcastle Ottawa Quality Assessment Scale (NOS) for longitudinal studies. The review protocol was registered with the International Prospective Register of Systematic Reviews (CRD420251029090). Results: Four longitudinal studies reporting the association between oral health and healthy ageing were recognised and included. All selected studies were considered of good quality according to the NOS. The studies varied in defining and measuring healthy ageing, the follow-up period, the sample size, and the measure of oral health; therefore, it was not possible to perform a meta-analysis. The studies included in the review demonstrated a positive relationship between the number of natural teeth and healthy ageing. Discussion: Despite variations in the definition of healthy ageing and the application of different oral health indicators, the review identified significant associations between the number of natural teeth and trajectories of healthy ageing. Conclusions: This review recognised significant longitudinal associations between oral health measures (number of teeth) and trajectories of healthy ageing. The findings emphasise the need to incorporate oral health into research and policy related to healthy ageing. Full article

The B Corp certification is a voluntary designation granted by B Lab. This nonprofit organization evaluates two main aspects of a company’s operations: the positive impact generated by its daily activities and how its business model reflects unique practices that yield positive outcomes for its stakeholders. Sistema B is at the forefront of the B movement in Latin America and the Caribbean, working to develop an ecosystem that enables B Corps to harness market forces to address social and environmental challenges. However, the B Corp movement in this region faces significant challenges, primarily due to a lack of government support, including tax benefits and legal recognition. This study aims to advance the existing literature on B Corps by examining sustainability-oriented hybrid organizations that strive to reconcile profit generation with social impact within the context of Mexico’s socioeconomic landscape. Additionally, it seeks to enhance the understanding of how ventures navigate trade-offs between financial and social objectives, and to identify factors that can help address these challenges. Twenty semi-structured interviews were conducted with Mexican B Corps to explore the entrepreneurial motivations related to social objectives, the B Corp movement, and the internal organizational dynamics of balancing social and economic logics. We discuss how tensions arise and are managed, as well as the issues regarding regulatory tensions in Mexico and the challenges that stem from organizational complexities. Future research directions are also outlined. Full article

Background: Penile cancer is an uncommon malignancy in European and North America countries, accounting for less than 1% of malignant neoplasms. The etiology of penile cancer involves a complex interplay of clinical and behavioral factors, including phimosis, smoking, excess body weight, and HPV infection. The significance of these factors varies according to geographical and socioeconomic contexts. A comprehensive understanding of these interactions is essential for developing targeted prevention strategies and improving outcomes across diverse populations. However, the majority of existing studies originate from South America or Africa; there is a lack of data regarding these associations and prognoses in European populations, particularly in Central Europe, including Poland. Objectives: This study aimed to investigate the prevalence of well-established clinical and behavioral characteristics associated with penile cancer and their influence on penile cancer prognosis in a cohort of 153 patients who underwent surgical intervention at a single tertiary medical center in Central Europe. Materials and Methods: This retrospective study was conducted from October 2011 to October 2024 at a single tertiary medical center and included 153 patients who underwent surgical treatment for penile cancer during this period. Demographic and histopathological data were collected. A comprehensive, self-administered patient survey was conducted to identify the presence of potentially relevant clinical and lifestyle characteristics. Moreover, the prevalence of human papillomavirus (HPV) in penile cancer specimens was determined using p16 immunohistochemistry. Results: The median age of the participants in the study was 64 years (range: 30–87). The predominant identified features were phimosis (47.06%), residence in small agglomerations (43.14%), obesity (43.14%), overweight (40.52%), and smoking (38.56%). HPV infection was detected in only 14.38% of the patients. Phimosis was associated with a more locally advanced penile cancer stage (T-stage). The stage of the primary tumor, lymph node involvement, and histopathological grading significantly affected patient survival, with a poorer prognosis observed in more advanced stages and associated with poorly differentiated histopathological features. Among all the examined clinical and lifestyle characteristics, only smoking demonstrated a significant two-fold higher risk of mortality and was associated with a significantly lower overall survival compared to the absence of smoking (p = 0.047). Conversely, human papillomavirus (HPV) infection was associated with a six-fold reduction in the risk of death (p = 0.063). Conclusions: Phimosis was the most frequently observed clinical characteristic in our cohort study and was correlated with a more advanced penile cancer tumor stage. Smoking was associated with lower rates of patient survival, while HPV-positive patients demonstrated a trend toward lower mortality compared to HPV-negative patients. Full article

Background: Social determinants of health—including both adversity and socioeconomic position—are known to shape physical health, health-related behaviors, and overall well-being. However, the psychological mechanisms that link these determinants to diverse outcomes remain insufficiently explored across international contexts. Objective: The objective of this study is to test whether sense of mastery and control over one’s life mediates the associations between key stressors (childhood abuse, financial insecurity) and socioeconomic resources (education, employment, and marital status) with a wide range of outcomes spanning health, behaviors, and well-being. Methods: Using cross-sectional data from Wave 1 of the Global Flourishing Study (GFS), we analyzed responses from more than 200,000 adults in 23 countries. Predictors included exposure to childhood abuse, perceived financial insecurity, and indicators of socioeconomic position (education, employment, and marital status). Outcomes included self-rated physical and mental health, depression, anxiety, smoking, drinking, physical activity, life satisfaction, and happiness. Structural equation modeling (SEM) was used to evaluate both direct and indirect (mediated) effects through sense of mastery and control over life. Results: Stressors were associated with poorer health, higher engagement in risk behaviors, and lower well-being. In contrast, higher levels of education, employment, and being married were linked to more favorable outcomes. In all tested models, sense of mastery and control over life significantly mediated the effects of both stressors and socioeconomic resources on health, behaviors, and well-being outcomes. Conclusions: Sense of mastery and control over life may represent key psychological pathways linking both adversity and social advantage to diverse health-related outcomes. Interventions that enhance individuals’ perceived control may offer cross-cutting benefits to improve health, promote well-being, and reduce behavioral risk factors globally. Full article

Background/Objectives: Mental health conditions represent a growing global health concern, disproportionately impacting populations in low- and middle-income countries like Pakistan. Limited epidemiological data, coupled with recent socioeconomic and environmental disruptions, has intensified the need for current insights into psychological burden and coping capacities in the Pakistani population. Methods: A descriptive, cross-sectional survey was conducted from January to May 2023 among 400 community-dwelling adults attending outpatient departments in Islamabad and Rawalpindi. A structured 75-item questionnaire incorporating validated tools (PHQ-9, GAD-7, WHO-5, CSES, and SRQ-20) was used to assess depression, anxiety, well-being, coping self-efficacy, and mental distress. Descriptive statistics, χ² and Fisher’s exact tests, and Spearman’s rank correlation (r_s) analyses were performed using IBM SPSS 22.0. Results: Most respondents were male (73.0%), aged 25–34 (60.0%), and urban-dwelling (80.0%). Clinically relevant depression and anxiety were observed in 57.0% and 19.5% of participants, respectively; 38.0% reported mental distress. Conversely, 76.5% demonstrated fair-to-good coping efficacy and 51.0% had high well-being scores. Younger age (≤34 years), higher income, urban residence, and male gender were associated with significantly better mental health outcomes. Strong positive correlation was found between PHQ-9 and GAD-7 scores (r_s = 0.672), and moderate negative correlations were found between GAD-7 and WHO-5 (r_s = −0.496), and PHQ-9 and WHO-5 (r_s = −0.310). Conclusions: Our findings highlight the significant psychological burden among urban Pakistani adults, alongside promising levels of resilience and coping self-efficacy. These results emphasize the urgent need for early, culturally adapted mental health screening and intervention programs in outpatient settings. Integrating such strategies into primary care, particularly for vulnerable subgroups like women, older adults, and those with lower income could facilitate timely diagnosis, improve outcomes, and reduce stigma surrounding mental health. Full article

Background/Objectives: Sexual attitudes, particularly those on the erotophilia (positive openness) to erotophobia (negative fear) scales, play a critical role in shaping behaviors and health decisions. While associations between sexual behavior and substance use have been documented, limited research has explored how sexual attitudes relate to mental health and substance use among Latin American university populations. This study aimed to examine the associations among erotophilic attitudes, mental health symptoms (anxiety and depression), substance use risk, and sexual behaviors in Mexican university students. Methods: A cross-sectional observational study was conducted between 2019 and 2023 with 1475 undergraduate students aged 17–25 years. Participants completed the Revised Sexual Opinion Survey (R-SOS) to assess sexual attitudes, the Hospital Anxiety and Depression Scale (HADS) for mental health evaluation, and adapted items from the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) to measure substance use risk. Erotophilic attitudes were defined as R-SOS scores ≥ 70. Statistical tests included the Kolmogorov–Smirnov test for normality, t-tests or Mann–Whitney U tests for group comparisons, Fisher’s exact test for categorical variables, and Spearman’s correlations. Multivariate binary logistic regression was used to calculate adjusted odds ratios (AdORs) and 95% confidence intervals (CIs), with a significance level of p < 0.05. Results: Erotophilic students were more likely to be male, older, initiate sexual activity earlier, and report a greater number of sexual partners. Erotophilia was positively associated with anxiety and tobacco, alcohol and marijuana use, and negatively associated with depressive symptoms. Multivariate analysis indicated that erotophilia was independently associated with male sex, age ≥ 20, higher anxiety, lower depression, low socioeconomic status, and increased risk of tobacco and marijuana use. Lower rates of consistent condom use were also reported among erotophilic individuals. Conclusions: Erotophilia may serve as a behavioral risk marker linked to anxiety symptoms and increased substance use, but not to depression. These findings highlight the need for integrated interventions addressing sexual health, substance use, and mental well-being in university populations. Full article

Background and Objectives: Breast reconstruction following mastectomy improves quality of life and psychosocial outcomes, yet it is not consistently performed despite multiple federal mandates. Current data shows decreased reconstruction in minority races, those with a low socioeconomic status, and those holding public health insurance. Many barriers remain misunderstood or unstudied. This study examines barriers to post-mastectomy breast reconstruction to promote a supportive clinical climate by addressing multifactorial obstacles to equitable access to care. Materials and Methods: The California Cancer Registry Data Surveillance, Epidemiology, and End Results (SEER) database and California Health and Human Services Agency Cancer Surgeries Database (2013–2021 and 2000–2021, respectively) were used in this retrospective observational study on mastectomy with immediate breast reconstruction (IBR), delayed breast reconstruction (DBR), or mastectomy only (MO) rates. Data were collected on age, sex, race, insurance type, hospital type, socioeconomic status, and residence. Pearson’s chi-square analysis was performed. Results: We found that 168,494 mastectomy and reconstruction surgeries were performed (82.36% MO, 7% IBR, 10.6% DBR). The 40–49 age group received significantly less MO (38.1%) compared to the 70–74 age group (94.8%, (p = <0.001). Significantly more reconstruction was carried out in patients with private, HMO, or PPO insurance (IBR 75.86%, DBR 75.32%, p = <0.001). Almost all breast surgeries were in urban areas as opposed to rural/isolated rural areas (96.02% vs. 1.55%, p = <0.001). There was no significant difference between races. Of all surgeries, 7.46% were completed in a cancer center with significantly higher rates of IBR. LA County, San Luis Obispo/Ventura County, and Northern CA had significantly more MO than other regions (p = <0.001). Conclusions: Reconstruction rates after mastectomy are low, with only 17.64% of patients undergoing reconstruction. Nationally, 70.5% of patients received MO, with 29.6% undergoing reconstruction. Significant factors positively contributing to reconstruction were private insurance, high SES, cancer center care, and urban residency. Identified barriers include public health insurance enrollment, rural or non-urban residence, older age, low SES, and non-white race/ethnicity, indicating potential monetary influences on care. Full article

Investing in renewable energy is a key driver for achieving the objectives outlined in the 2015 Paris Agreement. In this context, Brazil has stood out, and this study investigates the socioeconomic impacts of different types of renewable energy projects across Brazilian municipalities. The analysis focuses on projects installed after 2010, from which investments in non-conventional sources have grown substantially in the country. The applied methodology combines Propensity Score Matching and Difference-in-Differences techniques to analyze the average impacts and source-specific effects of hydro, wind, and photovoltaic solar projects on GDP per capita and formal employment. The results indicate an average positive effect of 16.8% on GDP per capita, with wind power having the greatest impact, and 6.7% on formal employment, where hydropower stands out. Therefore, this work provides valuable insights for policymakers and companies, who can use the findings to make decisions and direct investments based on the various dimensions of the Triple Bottom Line. Full article