Search Results (6,146)

Background/Objectives: It is well documented that people with human immunodeficiency virus (HIV) have nearly twice the risk of incident acute myocardial infarction compared to the general population. The elevated risk stems from a multi-layered interplay of factors such as persistent immune activation inherent to HIV infection and higher prevalence of traditional risk factors associated with nutritional needs. A large proportion of people living with HIV (PWH) reside in Sub-Saharan African countries such as Tanzania; however, there is a dearth of data on nutrition, particularly fruit and vegetable (F&V) intake, a key factor in the prevention of cardiovascular disease (CVD). This study aimed to contribute to the growing literature on CVD prevention for PWH globally. Methods: We conducted secondary analyses of original data collected from a study using the World Health Organization (WHO) STEPS survey among PWH and the general population in Mwanza City between December 2018 and May 2019. Approval for the parent study was obtained from Bugando Medical Center. Multinomial logistic regression analysis examined F&V intake and associated factors between PWH and people living without HIV (PWoH) using sex, employment, and BMI. Results: A total of 537 participants (277 PWoH and 260 PWH) were included in the analysis. PWH were more likely to consume fruits ≥ 4 days per week than PWoH (38% vs. 25%, p = 0.002), whereas vegetable intake did not differ significantly between groups. Fruit intake was higher in males (OR = 5.63; 95% CI: 2.48–12.79) and employed individuals (OR = 3.85; 95% CI: 1.82–8.14). Conclusions: PWH were more likely to consume more fruits than PWoH in this study, a phenomenon that is more novel than previous research. These findings are encouraging to support nutrition-based interventions for PWH who are at a higher risk of CVD. Full article

Background/Objectives: The COVID-19 pandemic presented an urgent global need to quickly vaccinate health workers (HWs). We used this unique circumstance to assess whether mature influenza vaccination programs for HWs facilitated rapid deployment of COVID-19 vaccines in low- and middle-income countries (LMICs). Methods: We used publicly available population-level COVID-19 vaccination coverage data from the World Health Organization (WHO) COVID-19 PowerBI Dashboard for 60 LMICs to investigate general population coverage with the COVID-19 vaccine over the first year of vaccine rollout. We also evaluated country-level policy and program data reported to the WHO–United Nations Children’s Fund (UNICEF) electronic Joint Reporting Form (eJRF) in 2022 or earlier to determine if the presence of a mature (≥2 years of influenza vaccine introduction in HWs prior to 2019) HW influenza vaccination program was associated with more rapid COVID-19 vaccine deployment and/or pandemic preparedness. We used a mixed-effects beta regression model to investigate whether having a mature HW influenza vaccination program was associated with COVID-19 vaccination coverage levels and/or deployment timeliness. Finally, to provide a better understanding of the possible relationship between the presence of a mature HW influenza vaccination program and the COVID-19 vaccine rollout, we analyzed interview data collected during COVID-19 vaccine post-introduction evaluations (cPIEs). Results: Twenty-four of our study countries (40%) had mature HW influenza vaccination programs prior to the COVID-19 pandemic, and 16 (27%) participated in cPIEs. The overall adjusted mean general-population COVID-19 vaccination coverage at 12 months post-deployment in countries with mature HW influenza vaccination programs was 46% (95% CI: (35%, 56%)), compared with 25% (95% CI: (19%, 32%)) in countries without such programs. Vaccination coverage was 2.5 times higher in countries with mature programs (adjusted odds ratio 2.5, 95% CI: (1.5, 4.5); p = 0.001). Conclusions: Our analysis suggests that mature influenza vaccination programs for HWs were associated with timelier and more complete COVID-19 vaccination rollout. Full article

Rapid urbanization and spatial constraints in high-density residential areas pose significant challenges to public health and well-being. This study investigates the mechanisms by which the visual environment of urban micro public spaces shapes residents’ psychophysiological responses to encourage spontaneous physical activity and advance active health. Using machine learning and 11-based semantic segmentation, 9 core visual elements across 20 micro public space scenes in high-density urban neighborhoods were quantified. An immersive virtual reality (VR) experiment was conducted, collecting synchronized multimodal psychophysiological data from 60 participants, which yielded 600 valid observations. Through an analytical framework combining Self-Organizing Map (SOM) clustering and Random Forest (RF) modeling, three distinct functional archetypes were identified: Restoration-Supporting, Activity-Promoting, and Stress-Inducing. The Activity-Promoting archetype was most effective in fostering spontaneous activity intention, characterized by a high proportion of activity areas, a moderate sky view factor, and minimal physical barriers. RF modeling further pinpointed pedestrian density, activity area ratio, and green space ratio as key visual drivers of health-promoting outcomes. Based on these findings, a “Visual Activation for Active Health” framework is proposed. It posits that moderate visual-environmental stimulation is the core mechanism for transforming passive spaces into health-promotive settings, thereby establishing a theoretical foundation for the evidence-based design of healthy and sustainable urban environments. Full article

As heritage museums shift toward more experience-oriented development, fragmented layouts and discontinuous visitor flows can reduce both spatial efficiency and the coherence of on-site experience. This study proposes an immersive experience-centred evaluation framework for exhibition layout in heritage museums, intended to translate experience goals into practical and diagnosable criteria for spatial optimization. An indicator system was refined through two rounds of Delphi consultation with an interdisciplinary expert panel, resulting in a hierarchical framework comprising five dimensions and multiple indicators. To support intervention prioritization in design and operations, weights were derived using the Group Analytic Hierarchy Process (GAHP), with Aggregation of Individual Judgments (AIJs) and consistency checks applied to control group judgement quality. A CV–entropy procedure was further used to support prioritization at the third-indicator level. Importance–Performance Analysis (IPA) was then employed to convert “importance–fit” assessments into an actionable sequence of optimization priorities. The results indicate that narrative and scene design carries the greatest weight (0.2877), followed by circulation and spatial organization (0.2281), sensory experience and atmosphere (0.1981), authenticity and sense of place (0.1644), and interactivity and participation (0.1217), suggesting that a “narrative–circulation–atmosphere” chain forms the core support for immersive layout design. A feasibility application using the Yinxu Museum demonstrates the framework’s value for benchmarking and diagnosis, helping decision-makers enhance visitor experience while respecting conservation constraints and more precisely target spatial investment priorities. Full article

Digital transformation poses significant challenges to employee well-being, particularly in public administration, where hierarchical structures, increasing digitalization pressures, and high mental health-related absenteeism underscore the need to understand individual and job demands and resources. This study explores these aspects from the perspectives of employees and supervisors in public administration. Between September 2023 and February 2024, semi-structured interviews were conducted with eight employees and eleven supervisors from public administration organizations in Northern Germany and analyzed using deductive–inductive qualitative content analysis based on the Job Demands-Resources model. Identified individual resources included technical affinity, error tolerance, and willingness to learn, while key job resources involved early and transparent communication, attentive leadership, technical support, and counseling services, with most job resources linked to leadership behavior and work organization. Reported job demands comprised insufficient participation, inadequate planning, and lengthy procedures, whereas personal demands included fears and concerns about upcoming changes and negative attitudes toward transformation. The variation in perceived demands and resources highlights the individuality of the employees’ experiences. The findings provide initial insights into factors influencing psychological well-being at work during digital transformation, emphasizing the importance of participatory communication, employee involvement, leadership awareness of stressors, and competence development. Future research should employ longitudinal and interventional designs to improve causal understanding and generalizability. Full article

Background: Attention Deficit Hyperactivity Disorder (ADHD) is associated with executive function deficits—such as planning, organization, and prospective memory—that impair autonomy and daily functioning, increase family stress, and create challenges in educational contexts. These consequences underscore the need for accessible and ecologically valid interventions addressing the cognitive, familial, and educational dimensions. Traditional approaches often lack ecological validity, and pharmacological treatment shows a limited impact on functional cognition. Objectives: This protocol outlines a feasibility study of DiverAcción, a web-based telerehabilitation system designed to enhance functional cognition through interactive and gamified tasks integrated into a comprehensive healthcare programme. Methods: A quasi-experimental feasibility study before and after the study will recruit 30 participants aged 9 to 17 years with ADHD. The study comprises an initial face-to-face session for instructions and baseline assessment (T0), followed by twelve supervised online sessions over six weeks. Therapeutic support is provided via integrated chat, email, and two scheduled videoconference check-ins. Feasibility Outcomes: include recruitment, adherence, retention, usability (SUS), acceptability (TAM), satisfaction, user-friendly design, therapeutic alliance (WAI-I), and professionals’ attitudes toward technology (e-TAP-T). Exploratory Measures: include parental self-efficacy (BPSES), parenting stress (PSI-4-SF), ADHD symptomatology (SNAP-IV), executive functioning (BRIEF-2), time management (Time-S), emotional regulation (ERQ-CA), prospective memory (PRMQ-C), and health-related quality of life (KIDSCREEN-52). Analyses emphasize descriptive statistics for feasibility metrics (recruitment, adherence, retention, dropout and fidelity). Assessments are conducted post-intervention (T1) and at three-month follow-up (T2) and analyzed relative to baseline using repeated-measures ANOVA or Friedman tests, depending on data distribution. Conclusions: This feasibility protocol will provide preliminary evidence on the usability, acceptability, and implementation of DiverAcción. Findings will guide refinements and inform the design of a subsequent randomized controlled trial. Full article

Brain electrical activity, as recorded through electroencephalography (EEG), displays scale-free temporal fluctuations indicative of fractal behavior and complex dynamics. This study explores the use of the Higuchi Fractal Dimension (HFD) as a proxy of two complementary aspects of EEG temporal organization: local signal irregularity, interpreted within a Kolmogorov-type framework, and persistence related to temporal structure, associated with statistical complexity. The latter can be used to evidence persistence in the EEG signal, serving as an alternative to previously used approaches for estimating the Hurst exponent. Thirty-eight healthy participants underwent resting-state EEG recordings in open- and closed-eyes conditions. HFD was computed for the original signals to assess Kolmogorov complexity and for the signals’ cumulative envelopes to evaluate statistical complexity and, consequently, persistence. The results confirmed that HFD values align with theoretical expectations: higher for random noise in the Kolmogorov model (~2) and lower in the statistical model (~1.5). EEG data showed condition-dependent and topographically specific variations in HFD, with parieto-occipital regions exhibiting greater complexity and persistence. The HFD values in the statistical model fall within the 1–1.5 range, indicating long-term correlation. These findings support HFD as a reliable tool for assessing both the local roughness and global temporal structure of brain activity, with implications for physiological modeling and clinical applications. Full article

The purpose of this narrative review is to examine women’s cognitive health and to highlight its association with four major pillars: (1) aging, (2) estrogen decline and loss, (3) diet, and (4) neuroinflammation, and their contribution to cognitive decline, with a focus on this combination to increase awareness and address the progression and potential amelioration of Alzheimer’s disease (AD). Often overlooked, estrogen decline during perimenopause and loss of estrogen production from the ovaries after menopause negatively influences almost every tissue and organ in the body, including the brain. This estrogen loss leads to inflammation, as can poor nutritional choices, both of which have a profound impact on short- and long-term health and can increase the risk of dementia, including AD. Thus, this overview covers the following four pillars (1) a brief background on cognitive decline and AD with aging, (2) the importance of and changes in estrogen with aging, (3) influence of dietary choices on overall well-being and brain health, and (4) the biochemical and molecular mechanisms by which this combination of factors may lead to neuroinflammation, resulting in cognitive decline and AD. Finally, this review briefly presents a hypothesis on whether women during perimenopause should be administered estrogen to span the transition into menopause to protect against cognitive decline and possibly ameliorate the risk of AD. This article is based on previously conducted studies and does not contain new data/results (studies) of human participants or animals performed by the authors. Full article

Background/Objectives: The COVID-19 pandemic exposed global weaknesses in healthcare preparedness and highlighted the pivotal role of the World Health Organization (WHO) in coordinating responses and issuing technical guidance. Among these, the document “Rational use of personal protective equipment (PPE) for COVID-19 and considerations during severe shortages” (December 2020) aimed to standardize PPE use amid global scarcity. This study assessed the awareness, implementation, and perceived usefulness of this WHO guidance among Polish healthcare personnel and evaluated discrepancies between the WHO expectations and workplace realities. Methods: A cross-sectional, anonymous online survey was conducted between July and September 2025 among employees of 243 randomly selected healthcare facilities in Poland (constituting 20% of all hospitals). The original 24-item questionnaire covered the demographics, awareness and implementation of the WHO PPE guidelines, and perceptions of their effectiveness during and after the pandemic. Data were analyzed descriptively. Results: A total of 542 healthcare workers participated, predominantly nurses (56.8%) and physicians (12.2%), with 86.8% being female and 59.3% having over 20 years of experience. Most respondents (76.5%) reported familiarity with the WHO PPE document, and 63.1% confirmed its implementation in their institutions. Over two-thirds (68.0%) reported that the guidelines improved their sense of safety at work. The main barriers to implementation included staff shortages (52.9%) and insufficient local guidance (20.6%). In 2025, 52.3% continue to apply the WHO recommendations, and 70.8% believe they remain relevant in current practice. However, 80.2% indicated that the WHO guidance should be more closely adapted to local conditions. Conclusions: The WHO PPE guidance was widely recognized and reported as implemented by respondents from participating healthcare facilities, contributing to improved preparedness. Nonetheless, limited institutional support and inadequate local adaptation reduced implementation effectiveness. Future WHO recommendations should better align with national healthcare contexts to enhance preparedness for future crises. Full article

This study investigates the crucial role energy leaders play in driving strategic energy management (SEM) and accelerating cost savings within a manufacturing organization and consequently, the industrial sector. Whereas energy efficiency can be seen as an innovative business practice with irrefutable cost benefits, its effective implementation requires strategic leadership and a structured approach. This research analyzes data collected from 120 participants representing 71 companies attending the Energy Bootcamp events organized by the U.S. Department of Energy’s (DOE) Better Plants program. The collected data focused on the state of SEM implementation, the presence and responsibilities of energy leaders, and the formation and function of energy teams. The findings reveal a significant gap between the perceived importance of SEM and its actual adoption, highlighting the need for strong leadership to drive behavioral changes by championing energy efficiency initiatives. Results indicate that effective energy leaders possess a diverse skill set, including the ability to secure top management buy-in, foster a culture of energy consciousness, and collaborate across departments. This study emphasizes the importance of empowering energy leaders with clearly defined roles and responsibilities as well as the authority to build and lead cross-functional energy teams. Furthermore, integrating energy management into existing organizational structures and leveraging readily available resources are identified as key factors for successful implementation. This research underscores how dedicated leadership and effective SEM practices help achieve industrial energy efficiency goals, providing practical insights for organizations seeking to improve performance and contribute to a resilient future. Full article

There is little evidence of the implementation of the Principles for Responsible Investment in Agriculture and Food Systems between universities and businesses, and there is even less research that prioritizes people and implements sustainable development with a territorial focus. In this article, we address a form of collaborative work that integrates academia with business, where the Principles for Responsible Investment in Agriculture and Food Systems (CFS-RIA) are seen as an opportunity to promote and strengthen the management of a business in the communities where it operates, and determine a new way of working from its links with the university. The experience is developed in the provinces of Santiago Rodríguez, Valverde (Mao), and Dajabón in the Dominican Republic, with the aim of contributing, using this new approach, to economic, social, environmental, and governance development in the territory. The conceptual and methodological basis for the university–business link is Working With People, a model that integrates key elements of planning such as social learning, collaborative participation, and project management models. The main catalysts of the experience are the business values and the stakeholders who insert the principles into their programs and projects. Among these is an innovative Family Social Responsibility Program with female entrepreneurs and organic banana production. It is concluded that the implementation of the CFS-RIA Principles has a significant impact on the sustainable development of the region and that the university–business link reinforces the social responsibility of companies, providing an opportunity for the entry of new actors. Full article

This study aimed to examine the forms of golf experiences as serious leisure among Korean older adults and to explore in-depth through phenomenological research the perspectives on such leisure activities and the meanings of actual experiences in the process of enjoying leisure. Using snowball sampling, a total of six research participants who enjoy golf experiences as serious leisure were selected, and data were collected and analyzed through in-depth interviews and participant observations conducted over approximately three months from May to August 2024. Based on this, the collected content was initially coded, repeatedly reviewed, and systematically organized and categorized. In the second stage, the context and meaning of the identified topics and phenomena were confirmed and classified to derive results. The analyzed results were as follows: freedom and liberation, emotional stability and stress relief, social connection and belongingness, and reconstruction of self-identity and life values emerged as themes. The findings of this study demonstrate that golf experiences as serious leisure are valuable leisure activities that positively impact the daily lives of older adults, indicating the benefits of golf experiences as serious leisure. Full article

This study introduces the Sustainable Development Goals Achievement Measurement Framework (SDG-AMF), a novel analytical tool used to systematically evaluate the relationships between digitalization and the Sustainable Development Goals (SDGs). Unlike the United Nations (UN) E-Government Development Index (EGDI) and Organization for Economic Co-operation and Development (OECD) Digital Government Indicators (DGIs) frameworks, the proposed SDG-AMF links digitalization indicators to specific SDG outcomes using proxy-based time-series analysis. The SDG-AMF provides a unified, statistically grounded approach that connects digital development with measurable sustainability outcomes. Using direct, high-quality time-series data (2010–2024) from internationally recognized sources, the framework maps key digitalization indicators such as Internet penetration, e-government maturity, research and development (RD) expenditure, gross domestic product (GDP) per capita, and gender participation in information and communication technology (ICT) to the selected SDG targets (SDGs 4, 5, 8, 9, and 16). Through correlation and regression analyses, the study identifies enabling and inhibiting relationships, highlighting Saudi Arabia’s strengths in digital infrastructure and e-government maturity while emphasizing areas for improvement, such as civic participation and RD intensity. Comparative benchmarking with digitally advanced economies underscores Saudi Arabia’s strengths in Internet penetration and e-government maturity, while gaps in RD investment are identified. The SDG-AMF provides policymakers with a replicable roadmap and scalable model to align foundational connectivity and governance reforms with advanced digital transformation, facilitating progress toward achieving Sustainable Development Goals worldwide. This research contributes original methodological insights and equips stakeholders with practical tools to monitor, compare, and accelerate SDG progress in the digital era. Full article

Background/Objectives: Parkinsonian gait is characterized by impaired motor adaptability, altered temporal organization, and reduced movement variability. While data augmentation is commonly used to mitigate class imbalance in gait-based machine learning models, conventional strategies often ignore physiological differences between healthy and pathological movements, potentially distorting meaningful motor dynamics. This study explores whether preserving healthy motor variability while selectively augmenting pathological gait signals can improve the robustness and physiological coherence of gait pattern classification models. Methods: Eight patients with Parkinsonian gait patterns and forty-eight healthy participants performed walking tasks on the Motigravity platform under hypogravity conditions. Full-body kinematic data were acquired using wearable inertial sensors. A selective augmentation strategy based on smooth time-warping was applied exclusively to pathological gait segments (×5, σ = 0.2), while healthy gait signals were left unaltered to preserve natural motor variability. Model performance was evaluated using a hybrid convolutional neural network–long short-term memory (CNN–LSTM) architecture across multiple augmentation configurations. Results: Selective augmentation of pathological gait signals achieved the highest classification performance (94.1% accuracy, AUC = 0.97), with balanced sensitivity (93.8%) and specificity (94.3%). Performance decreased when augmentation exceeded an optimal range of variability, suggesting that beneficial augmentation is constrained by physiologically plausible temporal dynamics. Conclusions: These findings demonstrate that physiology-informed, selective data augmentation can improve gait pattern classification under constrained data conditions. Rather than supporting disease-specific diagnosis, this proof-of-concept study highlights the importance of respecting intrinsic differences in motor variability when designing augmentation strategies for clinical gait analysis. Future studies incorporating disease-control cohorts and subject-independent validation are required to assess specificity and clinical generalizability. Full article

Campus community gardens are expected to leverage disciplinary resources and spatial conditions to deliver ecological, educational, and social benefits beyond those of general community gardens. In China, these gardens are primarily established under the guidance of educational authorities, leading to issues such as significant homogenization and a lack of diversity, which hinders the full realization of their potential. This study investigates the potential factors influencing the development of campus gardens. Focusing on university campuses in Beijing, it employs stratified sampling and a questionnaire survey (n = 1008), utilizing methods including exploratory factor analysis (EFA), multiple linear regression, and analysis of variance (ANOVA) to systematically identify the factors affecting their differentiated development. The results indicate that: (1) the willingness to participate is collectively driven by four dimensions: “planting expectation,” “funding and site selection,” “personal motivation,” and “organizational support,” with “planting expectation” being the most significant factor. (2) Students’ academic disciplines influence their perceptions of the need for organizational support and spatial resources for gardens. (3) Campus location and size moderate the demand for gardens, with students in the urban expansion belt (between the 4th and 5th Ring Roads) and those from smaller campuses showing a stronger “pro-nature compensation” tendency. Based on campus spatial scale, urban location, and the academic backgrounds of participants, the study proposes integrated “space-organization” development strategies. This research provides targeted planning strategies for campus community gardens in China, aiming to leverage institutional disciplinary strengths, respond to participant needs, and maximize the gardens’ benefits. Full article