Search Results (2,175)

Background: Given the rising global prevalence of dementia and its complex etiology, involving genetic and environmental risk factors, the aim of the present exploratory study was to investigate how offspring of individuals with dementia perceive genetic risk and the role of diet in dementia prevention. Methods: A mixed-methods study was conducted in Greece. Overall, 118 offspring completed an online questionnaire assessing demographics, risk perceptions, and dietary beliefs and practices in dementia risk reduction. Additionally, 22 semi-structured interviews explored dietary beliefs, practices, and influencing factors using framework analysis. Results: Most participants (76.3%) recognized diet’s role in dementia prevention, while 52.5% perceived offspring as having increased genetic risk; 40.7% reported making dietary changes to reduce disease risk. Healthcare professional consultation was the factor most strongly associated with dietary modification (OR = 26.61, 95% CI 7.47–94.76, p < 0.001). Qualitative findings showed that, while dementia was viewed as severe, personal susceptibility was often perceived as uncertain or distant. Key barriers, facilitators, and the role of self-efficacy in adopting healthier dietary practices were also explored. Conclusions: Our findings identify personalized dietary counselling and risk communication as priorities for evaluation in future intervention studies, aimed at supporting the implementation of dietary modifications and reducing the gap between knowledge and behavior in dementia risk reduction. Full article

Dementia is a leading cause of disability and death worldwide, yet diagnosis in primary care remains substantially lower than expected, delaying access to treatment, support and future care planning. The Facing Dementia Together Practice Change Program was developed as a co-designed, multicomponent intervention to improve dementia diagnosis in Australian general practice. A mixed-methods process evaluation used the RE-AIM framework with the addition of Appropriateness. The intervention included Primary Health Network (PHN) engagement, GP education, clinical resources, audit and benchmarking reports, specialist support, and a dementia risk-alert tool. Data were collected through surveys, stakeholder interviews, website analytics and program documentation. Clinicians who participated reported increased confidence and changes in dementia-related clinical behaviours, while education, resources and benchmarking were perceived as valuable. However, overall reach was limited by competing clinical priorities, workforce pressures, lack of financial incentives, and PHN implementation challenges. The dementia risk-alert tool was feasible but achieved limited uptake because of software compatibility, usability concerns and incomplete electronic medical record data. Although the program was acceptable to participating clinicians, limited reach constrained its potential impact. These findings highlight organizational, workforce, digital infrastructure and policy factors that influenced implementation of multicomponent interventions in routine primary care. Full article

Occupational safety management in combined cycle power plant (CCPP) construction requires methods that can both prioritize multiple tasks and explain why critical scenarios arise. This article presents a hybrid case-study methodology integrating questionnaire-based semi-quantitative 5 × 5 risk matrices with task-focused HAZOP. An anonymous structured questionnaire was completed by 105 workers at a CCPP construction site (response rate 75.0%), covering eight major construction activities and four occupational groups. Likelihood and severity ratings were processed in RStudio 2025.09.2 to produce 5 × 5 risk matrices, distribution plots, and “High + Critical” prioritization indices. The highest-ranked tasks were then subjected to HAZOP in PHAWorks RA Edition (Version 1.0.9834). “Work at height” emerged as the highest-ranked perceived-risk activity across all groups, followed by lifting/load handling, chemicals/flammables, and electrical works. Safety technicians tended to assign more conservative ratings than labor personnel, indicating role-dependent differences in risk perception. The HAZOP analysis suggested that the plausible HAZOP-informed accident scenarios and control weaknesses were not only technical but also organizational, including failures in permit-to-work, lockout/tagout, exclusion-zone control, fall protection, and chemical handling discipline. The integrated hybrid workflow bridges rapid semi-quantitative prioritization and structured causal analysis, supporting the translation of field-based perceptions into targeted and actionable safety controls for dynamic energy-project worksites. The findings highlight the critical role of organizational discipline alongside technical measures and support the integration of structured risk assessment within occupational health and safety management systems in dynamic construction environments. Full article

Employment is an important determinant of psychological, social, and economic wellbeing, yet individuals with mental health disorders often face barriers to workforce participation. This study examined the impact of mental health disclosure on perceptions of trustworthiness, job suitability, and value to the company, focusing on Major Depressive Disorder (MDD), Emotionally Unstable Personality Disorder (EUPD), and schizophrenia. Using experimental vignette methodology, 330 participants evaluated a job candidate before and after a simulated HR background check, which revealed either no diagnosed mental disorder (control condition) or a diagnosis of MDD, EUPD, or schizophrenia. Quantitative analyses indicated that disclosure of mental disorders was associated with declines in perceived trustworthiness, suitability, and value. Qualitative thematic analysis revealed that hiring decisions were guided by concerns about emotional stability, absenteeism, and reputational risk, tempered by considerations of fairness, support, and reasonable workplace adjustments. Across the mental health disorder conditions, rejection rates were relatively low (6–16%). The findings highlight the nuanced role of HR background checks (which can include social media checks) in shaping employability evaluations. The study contributes to understanding how disclosure of mental disorders influences employability perceptions and provides practical implications for fostering inclusive employment practices. Full article

Background: Postpartum depression (PPD) is an important maternal mental health concern. Knowledge, self-efficacy, and social support may be associated with the recognition and severity of depressive symptoms. This study assessed PPD knowledge among pregnant women/mothers and adults from the broader population in Saudi Arabia and examined the associations of self-efficacy and perceived social support with depressive-symptom scores in the maternal group. Methods: A cross-sectional online survey was conducted in Saudi Arabia from January to March 2021. Convenience and chain-referral sampling were implemented through WhatsApp. The analytical sample included 432 pregnant women/mothers aged ≥18 years and 275 broader-population participants. Arabic-language questionnaires assessed sociodemographic characteristics and PPD knowledge; the maternal-group questionnaire also assessed depressive symptoms, self-efficacy, and perceived social support. Descriptive statistics, Pearson correlations, linear regression, and one-way ANOVA were used. Results: Good PPD knowledge was observed in 73.8% of the maternal group and 77.5% of the broader-population group. Self-efficacy (r = −0.246, p < 0.001) and perceived social support (r = −0.197, p < 0.001) were negatively correlated with depressive-symptom scores. Both variables were statistically significant in the regression model; self-efficacy had the larger absolute standardized coefficient (β = −0.246) compared with perceived social support (β = −0.197). Depressive-symptom scores also differed across categories of age, family income, education, and previous PPD history. Conclusions: The study demonstrated a relatively good level of knowledge about postpartum depression among the surveyed participants. Higher perceived social support and self-efficacy were associated with better maternal mental health outcomes, highlighting their important role in the context of postpartum depression. These findings underscore the relevance of knowledge, social support, and self-efficacy in understanding postpartum mental health among the study population. Full article

The introduction of Joint Clinical Assessments (JCAs) under the European Union Health Technology Assessment Regulation (EU HTAR) represents a major structural reform aimed at reducing fragmentation and duplication in clinical evidence assessment across Member States. While JCAs are intended to support national health technology assessment (HTA) processes through a common EU-level clinical evaluation, their integration into established national HTA and reimbursement systems remains untested at this early stage of implementation. This paper reports findings from two surveys conducted in 2025 among local affiliate representatives with expertise in relevant HTA and market access activities across 25 European countries (comprising 24 EU Member States and Norway), capturing early national perspectives on key aspects of JCA implementation. The surveys explored anticipated impact on national reimbursement timelines, current opportunities for early HTA advice and PICO input, approaches to handling post-JCA data availability, and nationally prioritised policy and implementation issues. Results indicate mixed expectations regarding the potential impact of JCA on reimbursement timelines, with perceived risks of delay largely viewed as possibly transitional and mitigable through national process adaptation. Respondents emphasised the importance of transparency in PICO consolidation and clarity on the use of JCA reports in national appraisals. Overall, the findings suggest that JCA may represent a reconfiguration rather than a centralisation of evidence assessment, with national influence exercised earlier in the assessment lifecycle. These insights provide policy-relevant input to inform ongoing EU HTA implementation and future refinement of the JCA framework. Full article

Background/Objectives: Although the exact etiology of Inflammatory Bowel Diseases (IBD) is not yet fully understood, recent evidence suggests that both genetic and dietary factors are involved in their pathogenesis. The aim of the present exploratory study was to investigate how first-degree relatives (FDRs) of individuals with IBD perceive familial risk and the role of diet in IBD onset and prevention. Methods: A mixed methods approach was followed. A total of 103 unaffected FDRs of individuals living with IBD in Greece participated in an online questionnaire examining demographic characteristics, disease-related knowledge, risk perception, and beliefs about the role of diet in IBD. In parallel, 16 semi-structured interviews explored participants’ beliefs, self-reported dietary practices, and the factors shaping them using a framework analysis guided by the Health Belief Model. Results: Exploratory quantitative findings indicated that belief in the role of diet was associated with higher odds of self-reported family dietary changes, while belief in genetic risk was associated with lower odds of self-reported family dietary changes. The findings did not characterize the nature, maintenance, or motivation of these changes. Qualitative findings provided a deeper understanding of participants’ beliefs, highlighting that diet was mainly viewed as relevant to IBD management rather than prevention. Fear of disease onset and healthcare professional guidance were perceived as key facilitators of dietary changes. Conclusions: Our findings highlight heterogeneous beliefs regarding familial IBD risk and self-reported family diet changes, and support future research addressing balanced familial-risk communication for unaffected FDRs. Full article

Data-driven urban governance increasingly seeks to incorporate the needs of different population groups, yet child-sensitive evidence for public street-space renewal remains limited in older urban districts. Most studies still evaluate environmental conditions through population averages, with insufficient attention to heterogeneous child groups that may require differentiated planning responses. Based on an analytic sample of 314 children retained from 343 usable questionnaire responses collected from children aged 6–12 in the older urban districts of Xi’an, China, this study integrates street-activity characteristics and age- and sex-standardized body mass index (zBMI) using an established person-centered analytical approach. Latent Class Analysis (LCA) was used to identify children’s activity–health profiles, and multinomial logistic regression was used to examine associations between individual, family, and perceived street-environment factors and profile membership. Three profiles were identified: high-activity–healthy, high-intensity active, and low-activity–high-risk. The model-estimated low-activity–high-risk profile represented 35.7% of the analytic sample, and children assigned to this profile reported the lowest perceived safety and convenience. The findings suggest that profile-based analysis may inform child-sensitive street-renewal prioritization. Perceived safety and convenience showed the strongest and most consistent associations with membership in either the high-activity–healthy or high-intensity active profile relative to the low-activity–high-risk profile. These findings are associative and do not establish the effects of street interventions. The study therefore represents a context-specific extension and planning application of established analytical methods. Full article

Access to clean drinking water is one of the main factors influencing public health during humanitarian crises. In the northern districts of the Gaza Strip, long-term warfare and mass migration caused serious damage to the water supply system, cutting off access to drinking water, limiting the availability of fuel and chemicals used for water chlorination, and increasing reliance on intermittent networks and water transportation services. The present study is a descriptive cross-sectional study of water quality and health risks in 11 emergency camps. Water samples were collected from supply points, communal tanks, and household storage containers and analyzed for key physicochemical indicators (pH, turbidity, electrical conductivity/total dissolved solids, residual free chlorine) and microbiological contamination (E. coli and fecal coliforms). Household surveys documented transport and storage practices, perceived service adequacy, and recent gastrointestinal illness. Overall, 35% of samples exceeded WHO microbiological limits; E. coli was detected in 28% of household containers and 24% of distribution tanks. Residual chlorine was <0.5 mg/L in 40% of samples and turbidity exceeded guidance in 18%. Forty-five percent of households reported transferring water using open/uncovered containers, and 42% reported gastrointestinal illness in the previous month, with higher reporting in sites showing microbial contamination. The results suggest that there are significant weaknesses in the source-to-point-of-use system during emergencies. The priority actions we recommend are, restoring residual disinfection; strengthening monitoring at important control points; improving hygienic transport and covered storage; and providing backup fuel and treatment supplies to minimize the risk of waterborne diseases in shelters in North Gaza. Full article

Gestational hypertension (GH) imposes physiological and psychosocial burdens that reduce maternal well-being. Health literacy (HL) and health-related quality of life (HRQoL) are important factors influencing self-care and perceived health. This study compared HL and HRQoL between pregnant women with and without GH during the second and third trimesters of pregnancy and examined the relationship between them. A prospective longitudinal comparative study was conducted involving 378 pregnant women. HL and HRQoL were assessed during the second and third trimesters using the 12-item Health Literacy Scale (HLS-12) and the 36-Item Short Form Health Survey (SF-36), respectively. Women with GH had lower median HRQoL and HL scores in the second and third trimesters (p < 0.05). Within the GH group, HRQoL declined from 80 (65–90) to 55 (40–65) in the physical functioning domain, with similar reductions in role limitation and general health domains. The percentage of women with low or moderate HRQoL increased markedly in the GH group (p < 0.001). HL differed significantly between groups; women with GH were more frequently classified as having inadequate or problematic HL (p < 0.001). Compared to normotensive women, pregnant women with GH have lower HL and HRQoL during the second and third trimesters. The two variables were moderately correlated. There is a further need to assess HL and HRQoL in women with high-risk pregnancies and to implement effective strategies to improve the affected domains. Full article

Background/Objectives: Seasonal influenza vaccination (SIV) coverage remains suboptimal among adults aged ≥50 years, and the COVID-19 pandemic might influence the determinants of SIV uptake. This systematic review aimed to identify determinants of SIV uptake among adults aged ≥50 years during and after the COVID-19 pandemic. Methods: We searched PubMed, MEDLINE, Embase, Web of Science, Global Health, CINAHL, Cochrane Library, APA PsycINFO, and APA PsycArticles for studies published between 1 December 2019 and 1 January 2026. The pooled prevalence of SIV uptake was synthesized using random-effects models in meta-analysis. Results: A total of 50 studies were included in the systematic review. COVID-19-related factors, such as perceived risk of co-infection with SARS-CoV-2 and seasonal influenza and concerns about potential interactions between COVID-19 vaccines and SIV, were determinants of SIV uptake. Other modifiable determinants included those that existed before the pandemic (e.g., knowledge and perceptions of seasonal influenza and SIV). Subgroup analysis showed that cost and inaccessibility were barriers to receiving SIV in places without a fully subsidized SIV, and perceived susceptibility and vaccine safety concerns were commonly identified as facilitators and barriers in studies with data collected after the pandemic. The pooled prevalence of SIV uptake among adults aged 50 years or above was 53% (95% confidence interval: 44–62%). Such uptake appeared lower among adults aged 50–64 years, in regions without a fully subsidized SIV, and after the COVID-19 pandemic. Conclusions: These findings could inform service planning and interventions promoting SIV uptake among adults aged ≥50 years in the post-pandemic era. More studies are needed to explore determinants specific to people aged 50–64 years to inform health promotion tailored to their needs. Full article

The widespread penetration of generative artificial intelligence is reshaping adolescents’ social ecosystems and emotional experiences, while challenging the interpretive boundaries of traditional connectedness theories. Following the logical path of “connotation reconstruction–extension transformation–concept construction”, this study integrates the ethics of care and neo-ecological theory to systematically construct a theoretical framework of artificial intelligence connectedness. First, tracing theories across philosophy, sociology, and psychology, this research reconstructs the core connotation of connectedness rooted in the ethics of care, proposes the continuum hypothesis of caring relationships, and clarifies AI’s unique position on this continuum. Second, from the neo-ecological perspective, this paper sorts out the extended structure of connectedness and demonstrates the ecological shifts brought by the rise of virtual microsystems and the entry of AI actors. On this basis, the study formally defines artificial intelligence connectedness and establishes its three-dimensional structure: demand identification, two-way behavioral engagement, and responsive confirmation. Through systematic comparison with adjacent concepts, this paper identifies its uniqueness and positions it as a specific subtype of connectedness for the digital era. It defines it as a perceived bond that is both psychologically real and ethically asymmetric, carrying asymmetric risks under particular usage conditions and design logics. Finally, this paper builds a dual interpretive framework integrating traditional connectedness and artificial intelligence connectedness, verifies its incremental validity and unique predictive power, and puts forward falsifiable research propositions. This study expands the boundary of connectedness theory and provides an integrated analytical framework for parsing the complex mental health mechanisms of adolescents in the digital age. However, it should be noted that the artificial intelligence connectedness proposed in this study is currently a theoretical construct; its scientific validity and applicability remain to be verified through the development of standardized measurement tools and systematic empirical research. Full article

The growing demand for eggs from alternative housing systems is driven by perceived nutritional and welfare benefits. However, the trade-off between enhanced bioactive composition and exposure to environmental contaminants remains insufficiently explored. This study evaluated the physical traits, bioactive compounds, and heavy metal content of 480 commercially available table eggs from four housing systems: organic, free-range, barn, and enriched cages. Organic eggs exhibited the highest albumen quality, expressed by Haugh units (92.03 vs. 70.86 in cages) and lysozyme activity (144,877 U/mL vs. 119,830 U/mL in cages), alongside the highest concentrations of fat-soluble vitamins (e.g., vitamin A at 1600 μg/100 g and vitamin E at 3267 μg/100 g) and n-3 polyunsaturated fatty acids, including docosahexaenoic acid (DHA: 0.673% vs. 0.360% in cages). Conversely, organic eggs presented the weakest eggshells (breaking strength of 34.19 N vs. 47.05 N in cages) and a less favourable lipid profile regarding atherogenicity (AI: 0.411) and thrombogenicity (TI: 3.455) indices. Crucially, organic eggs contained significantly higher levels of lead (0.361 mg/kg) compared to indoor systems (0.041 mg/kg in barn and 0.102 mg/kg in cages), highlighting their susceptibility to environmental pollution. Cage and barn eggs were associated with higher chemical safety and shell strength but demonstrated a lower overall bioactive value. Ultimately, the choice of table eggs may involve a trade-off between the health-promoting benefits of extensive systems and the potential risks of heavy metal contamination, emphasising the need for integrated food safety management. Full article

Background/Objectives: Musculoskeletal injuries are highly prevalent among musicians, with the neck and shoulders being the most frequently reported areas of pain. Preventive education should be included to help understand and avoid health risks associated with musical performance. The objective is to assess the level of satisfaction with a workshop on injury prevention among string and wind musicians, and to determine the prevalence and location of their musculoskeletal pain. Methods: This was an observational study consisting of the administration of a questionnaire following a workshop on musculoskeletal injury prevention. Inclusion criteria: string and wind musicians aged between 11 and 20 years. Results: A total of 83% were bowed string musicians. A total of 98.3% of participants indicated that the duration was appropriate, with a score of 8.9 for both overall satisfaction and perceived usefulness in instrumental practice. Thirty-five musicians reported musculoskeletal pain at some point in their lives, and it was present in 12 participants during the previous week. The most common pain locations were the left shoulder and left hand (45% and 40%, respectively), the cervical region (35%), and the right shoulder (33%). Conclusions: Musicians show a high level of satisfaction with the workshop received, considering it interesting and important for their instrumental practice. In addition, the participants expressed a high level of intention to carry out the proposed exercises. The prevalence of musculoskeletal pain is high, particularly in the shoulders, left hand, and cervical region. Full article

Background/Objectives: Cardiovascular diseases are the leading cause of morbidity and mortality in older adults and are frequently associated with multidimensional frailty and reduced quality of life. The present study aimed to investigate the associations among multiple domains of the Comprehensive Geriatric Assessment (CGA), including frailty, cognitive status, emotional status, nutritional status, functional status, fall risk, psychological resilience, and perceived quality of life, in older adults with cardiovascular disease. Methods: A cross-sectional observational study was conducted on 100 patients aged ≥60 years admitted to the Geriatrics Department of the “Dr. C.I. Parhon” Clinical Hospital, Iași. Cognitive, emotional, nutritional, and functional status, fall risk, frailty (Fried and Tilburg scales), resilience- Connor–Davidson Resilience Scale-25 (CD-RISC-25), and quality of life- World Health Organization Quality of Life–BREF (WHOQOL-BREF) were assessed. Statistical analysis included chi-square or Fisher’s exact tests and exploratory discrimination analysis using ROC curves. Results: Overall, 61% of participants reported a very good quality of life, whereas the remaining 39% reported a moderately reduced quality of life. Better perceived quality of life was significantly associated with preserved cognitive status, fewer depressive symptoms, better nutritional status, lower frailty (as assessed by both the Fried Frailty Phenotype and the Tilburg Frailty Indicator), preserved functional independence, lower fall risk, and greater psychological resilience (all p < 0.05). In contrast, neither demographic characteristics nor cardiovascular diagnoses were significantly associated with quality of life. Exploratory receiver operating characteristic (ROC) analysis demonstrated modest discriminatory performance for cognitive status— Mini-Mental State Examination (MMSE) (AUC = 0.660; p = 0.007), nutritional status— Mini Nutritional Assessment (MNA) (AUC = 0.624; p = 0.038), and the Tilburg Frailty Indicator (AUC = 0.635; p = 0.024), whereas psychological resilience exhibited an inverse relationship with the predefined outcome (AUC = 0.293; p = 0.001). Conclusions: In hospitalized older adults with cardiovascular disease, perceived quality of life was primarily associated with multidimensional geriatric, functional, nutritional, cognitive, and psychosocial factors, rather than with demographic characteristics or cardiovascular diagnoses. Psychological resilience was identified as an important psychosocial correlate of better perceived quality of life, supporting its inclusion in individualized comprehensive geriatric interventions. These findings highlight the importance of comprehensive geriatric assessment in identifying factors associated with quality of life. Given the cross-sectional design, the observed relationships should be interpreted as associations rather than causal effects and require confirmation in prospective longitudinal studies. Full article