Search Results (717)

Background/Objectives: Health literacy represents the ability to access, understand, appraise, and apply health information for making appropriate health decisions. It is closely linked to education, income, employment, and overall health outcomes. Limited health literacy is associated with poor self-care, inadequate treatment adherence, and increased healthcare utilization. This study aimed to assess the level of health and medication adherence behaviors among primary health care users in Montenegro and examine its association with key demographic and socioeconomic factors. Methods: A cross-sectional, multicenter study was conducted among 202 primary health care users at the Primary Healthcare Center Danilovgrad, Plav and Ulcinj, Montenegro. Data were collected using a demographic questionnaire, the standardized European Health Literacy Questionnaire (HLS-EU-Q-47), and the Attitudes towards Medication Adherence Self-Reported Questionnaire (ADHERE-7). Statistical analyses included descriptive statistics, χ² tests, and univariate and multivariate regression. Results: The mean HLS-EU-Q Index was 33.55 ± 8.05. Significant differences in literacy levels were observed by age (p = 0.022), material status (p = 0.043), and self-rated health (p = 0.020). In multivariate ordinal regression analysis, lower income (<400 €) was associated with lower odds of belonging to a higher health literacy category (OR = 0.22, 95% CI: 0.02–0.92, p = 0.039), while no statistically significant associations were observed for gender, education level, or employment status after adjustment. The mean ADHERE-7 score of the study population was 21.78 ± 5.19. When analyzed in relation to the level of health literacy, the highest mean ADHERE-7 score was observed among participants with excellent health literacy (24.28 ± 4.90). Lower levels of health literacy were associated with lower odds of belonging to higher health literacy categories among participants reporting selected non-adherence behaviors, including missing therapy 3–4 times per week (OR = 0.30), frequently skipping prescribed medication when feeling well (OR = 0.03), and reducing or omitting therapy due to perceived lack of benefit or high costs (OR range: 0.10–0.31). Conclusions: Health literacy among primary care users in Montenegro is moderate, with a substantial proportion exhibiting limited literacy. Low income is a key determinant of limited literacy, and limited health literacy was associated with poorer medication adherence. Targeted educational and policy interventions are needed to improve health literacy and reduce health inequalities. Full article

Municipally provided water is low-cost, considered safe in most communities, and usually fluoridated to improve oral health. Yet, many Chicago region families report relying on other water sources. We investigated if safety and quality concerns were associated with these decisions; we also investigated whether there were spatial trends related to lead risk associated with water choice preferences. We used self-reported water consumption behavior data from the Coordinated Oral Health Promotion (CO-OP) Study, a longitudinal cohort of young children and their families. Respondents’ residences (N= 331) were geolocated at the census tract level. We evaluated associations between parent demographics, estimated lead risk and water preferences. Among those who “Never” gave their children tap water, we investigated demographic characteristics associated with viewing tap water as “Not safe”. Sixty-five percent (n = 216) of caregivers report that their child “Never” drinks tap water. Ordinal logistic regression indicates that parents aged <30 years are more likely to respond “Never” relative to “Sometimes” or “Always” (OR = 1.89; CI = 1.04, 3.40). Among those in the “Never” category, we grouped reasons into safety concerns (n = 114), observed quality concerns (n = 48), and preference (n = 40). We found that the decision not to give children municipal water is not aligned with the estimated lead risk. Understanding water consumption choice mechanisms is important for communities seeking safe and quality drinking water. Full article

Background: The term immigrant health paradox describes how immigrants often have better health outcomes than their American-born counterparts. While existing literature treats this phenomenon as broadly generalizable, emerging research indicates that its expression varies across cultural and migration contexts. Understanding how the immigrant health paradox may appear across specific ethnic groups requires research that maps variation rather than assumes uniformity. Objectives: This study seeks to describe patterns, explore variation by nativity, and identify factors associated with well-being among the Vietnamese population in the United States (US). By focusing on descriptive trends and contextual influences, the study aims to generate new insights into how the paradox may manifest—or diverge—in the Vietnamese context. Methods: We conducted an online survey asking participants about their depressive disorders, physical and mental health status, demographics, socioeconomic status, social networks, and experiences with daily discrimination. Descriptive statistics were used to describe the study sample. Linear regression and ordinal logistic regression were performed to explore the relationships. Results: In this exploratory analysis, we did not observe indications of the Vietnamese immigrant health paradox. Material factors, especially perceptions of financial needs, as well as psychological factors, were somewhat associated with how Vietnamese people living in the US assess their health. Conclusions: The absence of the Vietnamese immigrant health paradox in the US underscores the need for nuanced health models that reflect diversity within immigrant groups. Their experiences reveal how migration histories, structural barriers, and racialization shape health outcomes in ways that differ from expectations. Full article

Digitalization is a catalyst for the development of an information society, transforming how individuals interact with the world. However, its implementation across countries and regions has been uneven, contributing to social polarization and declining social trust. Among the most pressing concerns related to digitalization and inequality are the conditions of marginalized communities and persistent gender disparities. This study examines whether digitalization is associated with quality of life in marginalized areas and whether these effects differ between men and women. Using a quantitative approach, this study applies an ordinal regression model to data from two surveys conducted in 2021 and 2024 in a marginalized community in Mexico City. The results indicate that digitalization is significantly associated with quality of life: households possessing technological assets were 4.17 times more likely to report improvements in quality of life. Moreover, notable gender differences emerged. Although men’s quality of life increased by a factor of 35.7 in relation to digitalization, no statistically significant association was observed for women. The findings suggest a growing and statistically significant association between digitalization and quality of life in marginalized communities, but its benefits are distributed unevenly across genders. Full article

The potential of the adjacent categories approach for capturing the influence of explanatory variables on ordinal responses is investigated. Several models with increasing complexity in their linear predictors are considered, and their relationships are discussed, including the basic adjacent categories model, the stereotype model, models with category-specific effects, and dispersion models. For the adjacent categories framework, regularization methods for effect selection are introduced with the aim of distinguishing between no effect, global effects, and category-specific effects. Particular attention is given to the adjacent dispersion model, which provides a parsimonious parameterization while substantially improving model fit compared to the basic model. Effect selection for both the location and dispersion effects in the adjacent dispersion model is introduced. The proposed approaches are illustrated using several real data sets. Full article

Background: Low and middle-income countries (LMICs) such as Mexico are experiencing rapid population aging, accompanied by increasing levels of functional dependency and growing long-term care (LTC) needs. Objectives: We aimed to identify the factors associated with varying levels of functional dependency in order to assist population health planning and LTC policy in aging populations in Mexico. Methods: This cross-sectional study analyzed data from the 2021 wave of the Mexican Health and Aging Study (MHAS). Functional dependency was assessed through a modified Autonomie Gérontologie Groupes Iso-Ressources (AGGIR) scale, adapted to incorporate cognitive and physical assessments suitable for the Mexican context. Socioeconomic, health-related, and psychological variables were examined using ordinal logistic regression models. Results: Among 8049 participants included in the analysis, 87.08% were classified with non-to-mild dependency, 9.13% with moderate dependency, and 3.79% with severe dependency. More severe levels of functional dependency were associated with older age, lower educational attainment, not having a partner (being single, widowed, separated or divorced), and the presence of chronic conditions such as hypertension and cardiovascular disease. Conclusions: In contrast, higher educational attainment and regular physical activity were associated with less severe levels of dependency. These associations highlight the multifactorial nature of dependency in later life. The application of a graded, multidimensional dependency classification provides a more comprehensive and differentiated understanding of care needs than binary functional measures. This population-level perspective may support the prioritization of healthy aging strategies and long-term care planning in rapidly aging middle-income settings such as Mexico. Full article

Background: This study examined whether adverse drug reaction (ADR)-related hospital admissions or adverse drug events (ADE) in primary care are associated with changes in health-related quality of life (HRQOL), functional decline, and A&E visits, over time, in two separate prospective cohort studies of older adults in Ireland. Methods: The Adverse Drug reactions in an Ageing PopulaTion (ADAPT) (Study 1: N = 230) and the Centre for Primary Care Research (CPCR) (Study 2: N = 605) prospective cohorts were used. Participants completed health outcome questionnaires at baseline and again at 3 months (Study 1) and at 24 months (Study 2). ADR-related admissions and ADEs were assessed at baseline. Multivariable linear, logistic, and ordinal logistic regressions were used to examine associations between ADR-related admissions/ADEs and changes in HRQOL (EQ-5D-5L/3L), functional decline, and A&E visits, adjusting for age, sex, comorbidity, and polypharmacy. Results: In Study 1 (ADAPT cohort), frailty increased and A&E visits decreased over 3 months in both ADR/non-ADR groups (p < 0.01). In Study 2 (CPCR cohort), HRQOL decreased, and functional decline and A&E visits increased for both ADE/non-ADE groups over 24 months (p < 0.05). Individuals with ADEs had lower HRQOL and greater functional decline at both time points (p < 0.001). However, experiencing an ADR or an ADE was not significantly associated with changes in HRQOL, functional decline, or A&E visits over time, after adjustments. Conclusions: There were no substantial differences in the short-term healthcare burden of ADRs, while ADEs had poorer long-term outcomes. Full article

Accessible and comfortable public transportation is a cornerstone of sustainable and inclusive urban mobility. However, there is a knowledge gap in how interior layout influences riders’ comfort perception under constant occupancy conditions. We conducted a pilot laboratory experiment in Valparaíso, Chile using a full-scale urban bus mock-up. Twenty-five participants each experienced four seating scenarios (yielding 100 total observations per outcome) that varied seat pitch (20, 30, 45 cm) and seat orientation (forward-facing vs. side-facing). Cumulative link mixed models were used to estimate seat pitch and orientation effects on the comfort outcomes, with participant-specific random intercepts. Increased seat pitch dramatically improved comfort ratings (e.g., virtually no participants felt comfortable at 20 cm, whereas nearly all did at 45 cm). Side-facing bench seating (longitudinal orientation) yielded significantly higher comfort, legroom, and ease-of-movement ratings than the forward-facing configuration at ~30 cm pitch (p < 0.001). Within the tested mock-up conditions, the results suggest that seat pitch is a major driver of perceived comfort and in-vehicle usability, and that a side-facing bench layout (tested at ~30 cm spacing) can improve perceived spaciousness relative to forward-facing seating. Because this is a small, non-probability pilot sample and a partial factorial design, these findings should be considered preliminary design sensitivities that warrant validation in larger, in-service studies before informing fleet-wide standards. Full article

This study examines consumer behavior, preferences, and knowledge regarding honey in Kosovo to inform more effective production, marketing, and policy strategies. Data were collected from 503 respondents through an online questionnaire and analyzed using a combination of artificial neural networks (ANN), decision tree modeling (CHAID), and ordinal logistic regression. The results show a high prevalence of honey consumption, strong preference for locally produced honey, and significant variability in consumer willingness to pay (WTP) based on knowledge, income, and trusted information sources. ANN identified recommendations and product familiarity as primary predictors of WTP, while the decision tree highlighted knowledge and income as key variables for segmentation. The ordinal logistic regression confirmed the importance of perceived quality and product attributes, particularly botanical and geographical origin, in shaping purchasing decisions. The use of complementary statistical models enhanced both predictive power and interpretability. The findings highlight the crucial role of consumer education and trust cues in fostering sustainable honey markets in Kosovo. Full article

The article examines the implementation of 3D printing in civil protection and crisis management with a focus on the educational process, while 3D printing technology enables the creation of various teaching aids that streamline teaching and enrich theoretical knowledge. The empirical part of the study is based on a quantitative questionnaire survey among students of the Faculty of Safety Engineering of the University of Žilina in Žilina, with hypotheses set in advance and forming the basis for the construction of the questionnaire. The questionnaire collected data on the subjective evaluation of 3D printing through continuous, nominal, and ordinal responses and was completed by 277 students. Statistical methods of simple and group classification, as well as t-test, ANOVA, Kruskal–Wallis and Pearson’s correlation analysis were used to evaluate the data. Statistical significance was used to determine whether observed differences and relationships were unlikely to have arisen by chance. In addition, effect size measures were used in correlation and regression analyses to assess the strength and practical relevance of statistically significant relationships. The results of the study show that 3D printing significantly contributes to improving education and preparedness in civil protection, as it allows for more material-efficient and flexible production of educational aids compared to traditional custom production. Thus, it supports the development of more resilient communities and contributes to long-term sustainability. The findings confirmed that 3D printing is a suitable tool for improving public preparedness for emergencies. Full article

The energy transition in Ibero-American countries demands significant diversification, yet the vast potential of offshore renewable energies (ORE) remains largely untapped. Slow adoption is often attributed to the hostile marine environment, high investment costs, and a lack of institutional, regulatory, and industrial readiness. A critical barrier for policymakers is the absence of methodologically robust tools to assess national preparedness. Existing indices typically rely on simplistic weighting schemes or are susceptible to known flaws, such as the rank reversal phenomenon, which undermines their credibility for strategic decision-making. This study addresses this gap by developing a multi-criteria decision-making (MCDM) framework based on a problem-specific synthesis of established optimization principles to construct a comprehensive Offshore Readiness Index (ORI) for 13 Ibero-American countries. The framework moves beyond traditional methods by employing an advanced weight-elicitation model rooted in the Robust Ordinal Regression (ROR) paradigm to analyze 42 sub-criteria across five domains: Regulation, Planning, Resource, Industry, and Grid. Its methodological core is a non-linear objective function that synergistically combines a Shannon entropy term to promote a maximally unbiased weight distribution and to prevent criterion exclusion, with an epistemic regularization penalty that anchors the solution to expert-derived priorities within each domain. The model is guided by high-level hierarchical constraints that reflect overarching policy assumptions, such as the primacy of Regulation and Planning, thereby ensuring strategic alignment. The resulting ORI ranks Spain first, followed by Mexico and Costa Rica. Spain’s leadership is underpinned by its exceptional performance in key domains, supported by specific enablers, such as a dedicated renewable energy roadmap. The optimized block weights validate the model’s structure, with Regulation (0.272) and Electric Grid (0.272) receiving the highest importance. In contrast, lower-ranked countries exhibit systemic deficiencies across multiple domains. This research offers a dual contribution: methodological innovation in readiness assessment and an actionable tool for policy instruments. The primary policy conclusion is clear: robust regulatory frameworks and strategic planning are the pivotal enabling conditions for ORE development, while industrial capacity and infrastructure are consequent steps that must follow, not precede, a solid policy foundation. Full article

Metabolic acidosis is common after kidney transplantation and has been linked to adverse renal outcomes. However, its relationship with histological injury in kidney allografts remains poorly characterized. We aimed to explore the association between metabolic acidosis and histopathological features in kidney allograft biopsies. This single-center, cross-sectional observational study included 63 adult kidney transplant recipients who underwent clinically indicated allograft biopsies. Metabolic acidosis was defined as a serum bicarbonate level < 22 mmol/L at the time of biopsy. Histological lesions were assessed according to the Banff classification. Lesion severity was evaluated using descriptive statistics, nonparametric comparisons, ordinal logistic regression, and multivariable logistic regression models adjusted for renal function, proteinuria, and time from transplantation. Sensitivity analyses additionally adjusted for hemoglobin and donor-related variables. Patients with metabolic acidosis exhibited numerically higher severity scores for both acute inflammatory lesions and chronic histological changes, including total inflammation and interstitial fibrosis/tubular atrophy (IFTA). Across ordinal analyses and multivariable regression models, consistent directional trends toward a greater histological injury burden were observed among acidotic patients; however, none of these associations reached statistical significance, and confidence intervals were wide. Sensitivity analyses yielded directionally consistent effect estimates. In this biopsy-based analysis, metabolic acidosis showed consistent directional trends toward a higher burden of inflammatory and chronic histological lesions, although these findings did not reach statistical significance. Full article

Climate change brings considerable danger to India’s economic progress, with the agricultural sector and farmers’ livelihoods being particularly vulnerable. Himachal Pradesh is especially susceptible owing to its reliance on climate-sensitive economic activities and limited capacity to adapt to climate variability. Strengthening adaptation strategies in Himachal Pradesh is crucial for fortifying the resilience of communities reliant on environmental resources for their sustenance and economic well-being. This study examines the extent of adoption of Climate-Smart Agricultural Practices (CSAPs), identifies the factors influencing their uptake, and assesses their impact on the livelihood vulnerability of farm households in the temperate region of Himachal Pradesh. Using a multistage random sampling framework, data were collected from 432 farm households through primary surveys and secondary sources. The analysis employs descriptive statistics, a composite livelihood vulnerability index, and Ordinal Logistic and Multiple Linear Regression models. Results show higher adoption of low-cost practices such as composting, fruit-based agroforestry, crop–livestock integration, and mulching, while capital-intensive practices like micro-irrigation were limited due to financial constraints. Adoption is positively influenced by education, extension access, farming experience, financial resources, and climate information exposure. Importantly, CSAPs adoption is found to significantly reduce livelihood vulnerability, indicating enhanced resilience and reduced exposure to climate-induced risks among farm households. The findings highlight climate-smart agriculture as an effective adaptation strategy and underscore the need for policies that strengthen extension services, improve access to credit, and promote affordable climate-smart technologies to enhance resilience in vulnerable hill regions. Full article

Objective: This study investigates the association between consumers’ perceived readability of Multiple Traffic Light (MTL) label print size—a theoretical structural gatekeeper for visual salience—and self-reported food consumption frequency in the United Kingdom. We aimed to disentangle the effect of label readability from label content. Using non-equivalent dependent variables (NEDVs), we tested whether the association is specific to unhealthy convenience foods and absent for healthy or unlabeled foods, while also examining heterogeneity across consumer subgroups. Methods: Data from 8948 adults across four waves (2012–2018) of the UK Food and You Survey were analyzed. Cumulative link ordinal logistic regressions were employed to model the association between self-reported print size readability and the consumption frequency of four product types: pre-packaged sandwiches and pre-cooked meat (unhealthy, labeled targets), dairy (nutritionally advisable, labeled control), and fresh meat (unlabeled control). Models were adjusted for sociodemographic covariates, health behaviors, and survey wave fixed effects. Results: The findings reveal a content-specific and significant dynamic relationship exclusively for pre-packaged sandwiches. In 2012, a one-unit increase in readability was associated with a 9% decrease in the odds of frequent consumption ($OR=0.91$), consistent with a warning effect. However, by 2018, this relationship reversed to a 4% increase ($OR=1.04$), indicating that higher readability became associated with more frequent consumption. In contrast, a persistent null association was observed for pre-cooked meat, dairy, and fresh meat. Subgroup analyses for sandwiches indicated that the association with readability was strongest among less-engaged consumers. Conclusions: Empirical evidence challenges the utility of a standardized approach to food labelling. The results suggest that the effectiveness of label salience is contingent not just on the consumer but on the product’s context and the content of its message, highlighting the need for adaptive rather than uniform policy standards. Full article

Objectives: The choice between endovascular treatment and microsurgery for unruptured intracranial aneurysm (UIA) is influenced by aneurysm location, with middle cerebral artery (MCA) UIAs traditionally requiring surgery. This study compares these treatment modalities using propensity score matching (PSM). Methods: This single-center analysis included adults with saccular MCA UIAs who underwent treatment. PSM incorporated patient and aneurysm characteristics to create comparable groups. Results: Before matching, 124 patients underwent microsurgery and 28 underwent endovascular treatment. With a median follow-up of 76.5 months, 93.4% achieved good functional outcome (modified Rankin Scale [mRS] 0–2), including 117 (93.4%) in the surgical group and 25 (89.3%) in the endovascular group. Complications occurred in 15.3% of surgical and 10.7% of endovascular patients (p > 0.05). Three patients developed subarachnoid hemorrhage post-treatment: two from other aneurysms and one from an endovascularly treated MCA UIA. Proximal location predicted worse outcomes (p = 0.04), whereas distal location was associated with better outcomes (p < 0.01). Ordinal logistic regression revealed no additional associations. After PSM, we did not observe significant between-group differences in complications or mRS at follow-up, and ordinal logistic regression predicting mRS at follow-up revealed no differences. Distal MCA remained associated with better outcomes (p < 0.01). No differences in survival were found between groups before or after PSM (log-rank test p = 0.34 and p = 0.49, respectively). Conclusions: No differences in long-term outcomes or complications were observed in this cohort after endovascular treatment vs. microsurgery. Distal location was the only factor associated with favorable outcomes. At a median follow-up of 6.4 years, most patients achieved good functional outcomes. These results likely reflect individualized treatment selection within an experienced team and should be considered exploratory given limited statistical power and generalizability. Full article