Search Results (13,864)

Background: The Nutrition Improvement Program has been implemented in China for over a decade; however, its assessment in Hubei Province has not yet been systematically reported. This study evaluated the implementation outcomes of the Rural Compulsory Education Students’ Nutrition Improvement Program in Hubei Province. Methods: A multi-stage cluster sampling design with stratification by school type was used. Standardized questionnaires were administered to schools, districts, and students to assess the food environment, nutrition policies, and dietary behaviors. Anthropometric and biochemical measurements were collected from all participants in 2014 and 2023. Results: A total of 24 schools across six counties in Hubei Province were surveyed at two time points, comprising 8619 students (4388 in 2014 and 4231 in 2023). Between 2014 and 2023, the proportion of students in the Nutrition Improvement Program reporting satisfaction with school meals increased significantly, and average nutritional knowledge scores improved. Nevertheless, several deficiencies persisted: menus remained poorly aligned with dietary guidelines, food variety was limited, full-time nutrition or health teachers were scarce, and absolute levels of nutritional knowledge remained low. In 2023, the prevalence of undernutrition, overweight/obesity, and anemia among program participants was 9.5%, 15.9%, and 12.2%, respectively. Compared with girls, boys had higher rates of undernutrition and overweight/obesity and a lower anemia rate; the same pattern was observed in primary school students relative to junior high school students. Compared with 2014, the nutritional profile shifted markedly (p < 0.001). Undernutrition and anemia declined by 7.4 and 4.9 percentage points, respectively, whereas overweight/obesity increased by 6.9 percentage points. Conclusions: From 2014 to 2023, students in the Nutrition Improvement Program of Hubei Province experienced observable changes in nutritional status: the primary nutritional concern had shifted from undernutrition to overnutrition, and the prevalence of anemia has generally decreased, while it has increased in some areas. However, given the observational nature of the repeated cross-sectional design, causal inference regarding the program’s impact was not supported. Full article

Background/Objectives: This study aimed to assess oral health values, oral hygiene habits, preventive dental attendance, and lifestyle-related risk factors among students at the University of Osijek and to compare findings between students enrolled in health-related and non-health-related study programs. Methods: A cross-sectional survey was conducted among 331 students (186 health-related and 145 non-health-related). Participants were recruited using a convenience sampling approach. Data were collected using an anonymous questionnaire comprising demographic information, oral health–related behaviors, and the Croatian version of the Oral Health Values Scale (OHVS-CRO). Group differences were analyzed using nonparametric statistical tests. Results: Students enrolled in health-related study programs reported significantly more favorable oral hygiene behaviors, including more frequent toothbrushing, greater use of dental floss, interdental brushes, and mouthwash, as well as more regular preventive dental attendance (all p < 0.05). They also achieved significantly higher OHVS-CRO scores across all domains and on the total scale (median total score: 42 vs. 40; p < 0.001). No significant differences were observed regarding smoking, alcohol consumption, or refined sugar intake. Conclusions: Students enrolled in health-related study programs demonstrated higher oral health values and more favorable oral health-related behaviors than students enrolled in non-health-related study programs. These findings suggest an association between educational orientation and oral health values and behaviors and may inform future oral health promotion initiatives targeting university students. Full article

Background: Cardiovascular diseases (CVDs) are the leading cause of death in Saudi Arabia, and public knowledge of risk factors and warning signs supports early detection and prevention. This study aimed to assess CVD knowledge and its demographic predictors among adults in the Jazan region. Methods: A cross-sectional study was conducted among 382 adults (≥18 years) between February and April 2025. A questionnaire adapted from prior validated instruments assessed CVD awareness, knowledge of 11 risk factors and 10 warning signs, perceptions, and practices. Total knowledge scores (0–21) were dichotomized as adequate (≥8) versus inadequate (<8). Mann–Whitney U and Kruskal–Wallis tests were used for bivariate analysis, followed by binary logistic regression. Results: Most participants (89.5%) had heard of CVD, yet 53.7% had inadequate knowledge, and only 9.9% demonstrated good knowledge (≥15). The median total knowledge score was 7 (IQR 2–11) out of 21, with warning-sign knowledge (2.96/10) lower than risk-factor knowledge (3.95/11). Overweight/obesity (52.6%), hypertension (51.3%), and smoking (49.5%) were the most recognized risk factors; chest pain (47.6%) and shortness of breath (46.1%) were the most recognized warning signs. University education (aOR = 2.44, 95% CI 1.23–4.85, p = 0.011) and family history of chronic disease (aOR = 2.26, 95% CI 1.32–3.85, p = 0.003) were the only independent predictors of adequate knowledge. Conclusions: More than half of the surveyed adults in the Jazan region had inadequate CVD knowledge despite high general awareness. These findings suggest that targeted education using digital platforms and primary care providers may help improve knowledge of risk factors and warning signs in the region. Full article

Background/Objectives: Emotional eating (EE) is an emerging public health concern among university students, a population exposed to heightened academic demands, psychosocial stressors, and lifestyle changes that may promote maladaptive coping behaviors. EE has been linked to psychological distress, particularly depressive and anxiety symptoms, as well as sociodemographic, lifestyle, and anthropometric factors; however, findings remain heterogeneous and insufficiently integrated within comprehensive analytical frameworks. This study aimed to examine the association between EE and depressive and anxiety symptoms in university students, while assessing the independent contributions of sociodemographic, academic, lifestyle, and anthropometric determinants. Methods: A cross-sectional survey was performed among 1279 university students from 10 regions in Greece. Sociodemographic, academic, lifestyle, and anthropometric data were collected using validated instruments and standardized procedures. Depressive and anxiety symptoms were assessed by the use of the Beck Depression Inventory-II (BDI-II) and the six-item State-Trait Anxiety Inventory (STAI-6), respectively. EE was evaluated utilizing the EE subscale of the Three-Factor Eating Questionnaire–Revised 18 (TFEQ-R18). Multivariable ordinal logistic regression models were applied to examine independent associations. Results: In fully adjusted models, depressive and anxiety symptoms were the strongest correlates of higher EE levels, each associated with more than twofold increased odds. Female sex, Greek nationality, rural residence, enrollment in biomedical sciences, later academic years, and regular smoking were also positively associated with EE. Higher physical activity was inversely associated with EE levels. Overweight, obesity, and increased waist circumference and waist-to-hip ratio were consistently linked to higher EE, with several associations exceeding twofold increased odds. Conclusions: EE in university students is strongly associated with psychological distress and clusters with adverse lifestyle and anthropometric characteristics. These findings support the need for integrated interventions targeting mental health, lifestyle behaviors, and obesity-related risk factors. Longitudinal studies are warranted to clarify causal pathways and underlying mechanisms. Full article

The HEROn magazine was created as an innovation project by the S-TEAM team for the 2024/2025 SUBMERGED season of the FIRST^® LEGO^® League Challenge category. The primary aim of the HEROn project was to implement game-based learning methods to enhance environmental awareness, particularly concerning the protection of our water resources. This initiative is designed to engage individuals from ages 9 to 99 in a creative and enjoyable manner. At the core of the HEROn project is a well-known game that challenges players to find the differences between two photos. This activity not only provides entertainment but also educates participants about the importance of protecting and preserving the aquatic environment. By discovering subtle differences between images, players become more attuned to environmental issues, which promotes a deeper understanding and appreciation of water conservation. The chapters of the HEROn magazine are thoughtfully organised into themes, each focusing on various aspects of water’s importance, its protection, and sustainable usage. Additionally, a random sample of participants was surveyed to gather opinions and feedback on HEROn magazine as part of the project and this research. This feedback is invaluable for assessing the magazine’s impact and for improving future editions to better serve the goals of raising environmental consciousness. The online HEROn questionnaire consisted of 10 items and employed a 5-point Likert scale for responses. Data were collected over a three-month period (28 January–28 April 2025), with 630 Hungarian respondents participating in the survey. The HEROn magazine was generally well received, with mean scores ranging from 4.2 to 4.6. Age-group differences were examined using nonparametric Kruskal–Wallis tests, with Dunn–Bonferroni post hoc comparisons. These analyses show statistically significant differences between adults (30–89) and the younger cohorts for aggregated awareness, design/engagement, and branding measures, while teenagers (9–15) and young adults (16–29) did not differ significantly from each other. The Find-the-Difference game showed the greatest variability across groups, with young adults giving the lowest mean. Full article

Background: The Semipalatinsk Nuclear Test Site (SNTS) represents a unique example of long-term population exposure to ionizing radiation. This study aimed to assess the health status of individuals from three generations permanently residing in territories affected by radioactive contamination resulting from nuclear weapons testing at the SNTS, based on the findings of a population screening examination. Materials and Methods: A cross-sectional screening study was conducted among 2802 adults aged 18 years and older. The exposed group consisted of residents of the Abay and Beskaragai districts of the Abay Region and their descendants (n = 1358). The control group included residents of Arshaly village in the Akmola Region with no history of radiation exposure (n = 1444). All participants underwent a structured questionnaire survey, clinical examination, biochemical and hematological testing, and assessment of thyroid function. Individual radiation doses were obtained from the State Scientific Automated Medical Registry of Persons Exposed to Radiation (SSAMR). Results: Arterial hypertension (p < 0.001), chronic ischemic heart disease (p < 0.001), thyroid disorders (p < 0.001), malignant neoplasms (p = 0.003), renal diseases, and respiratory diseases were significantly more prevalent in the exposed population than in the control group. Exposed individuals also demonstrated significantly higher levels of total cholesterol, triglycerides, and the triglyceride-glucose (TyG) index, indicating increased insulin resistance. After adjustments, the only outcome that retained a statistically significant association with radiation dose was thyroid disorders (adjusted OR per 10 mSv increase = 1.017; 95% CI: 1.009–1.025; p < 0.001). ROC analysis demonstrated a moderate discriminative ability of radiation dose with respect to arterial hypertension (AUC = 0.715), chronic ischemic heart disease (AUC = 0.735), and ischemic stroke (AUC = 0.711). Conclusions: The findings suggest long-term adverse health effects associated with radiation exposure among populations residing near the SNTS. Continued epidemiological surveillance and medical monitoring of exposed individuals and their descendants are warranted. Full article

Objective: This study examined the prospective association between self-reported physical exercise and depressive symptoms among older adults, and further tested whether loneliness statistically accounted for this association and whether baseline cognitive emotion regulation strategies moderated the exercise–loneliness pathway. Methods: A two-wave prospective survey with a six-month interval was conducted among 980 community-dwelling older adults in Zhengzhou, China. Baseline data were collected in September 2024, and follow-up data were collected in March 2025. Physical exercise was assessed using the Physical Activity Rating Scale-3, depressive symptoms using the 10-item Center for Epidemiologic Studies Depression Scale, loneliness using the 8-item UCLA Loneliness Scale, and cognitive emotion regulation strategies using the short version of the Cognitive Emotion Regulation Questionnaire. Cross-lagged models were used to examine the residual prospective association between physical exercise and depressive symptoms. A two-wave prospective explanatory model was then tested to examine the role of follow-up loneliness, and moderated explanatory (half-longitudinal) analyses were conducted using baseline adaptive and maladaptive cognitive emotion regulation strategies as moderators. Results: Baseline physical exercise was significantly associated with lower depressive symptoms at follow-up after controlling for baseline depressive symptoms and covariates (β = −0.182, p < 0.001). In contrast, baseline depressive symptoms were not significantly associated with follow-up physical exercise (β = −0.016, p = 0.633). Baseline physical exercise was negatively associated with follow-up loneliness (β = −0.267, p < 0.001), and follow-up loneliness was positively associated with follow-up depressive symptoms (β = 0.324, p < 0.001). The indirect association through follow-up loneliness was significant (indirect effect = −0.087, 95% CI [−0.112, −0.065]). Baseline adaptive cognitive emotion regulation strategies strengthened the association between physical exercise and lower loneliness (interaction β = −0.076, p < 0.001), whereas baseline maladaptive strategies weakened this association (interaction β = 0.059, p = 0.004). Conclusions: Self-reported physical exercise was prospectively associated with fewer depressive symptoms among older adults six months later. This association was statistically accounted for, in part, by lower follow-up loneliness, and baseline cognitive emotion regulation strategies were associated with the strength of the exercise–loneliness association. Because this study used a two-wave observational design with the explanatory variable and outcome measured at the same follow-up wave, the findings should be interpreted as prospective associations rather than evidence of causal or temporal mediation. Full article

Background: Malocclusion has important functional, esthetic, and psychosocial consequences; however, access to orthodontic treatment remains uneven and strongly influenced by socio-economic factors. While these disparities are well documented internationally, evidence from Romania remains limited. This study aimed to evaluate the influence of socio-economic factors on orthodontic treatment initiation within the Romanian population. Methods: A cross-sectional questionnaire-based study was conducted in 2025 using an online survey distributed through social media and community networks. A total of 285 adults were included. Data were analyzed using descriptive statistics, chi-square tests, and multivariable logistic regression. Results: Overall, 56.5% of respondents reported having undergone orthodontic treatment. Age and self-perceived information level were significantly associated with treatment initiation in the multivariable model. Participants older than 30 years were significantly less likely to have undergone orthodontic treatment compared with those aged 18–30 years (OR = 0.28, 95% CI: 0.12–0.62, p = 0.002). Higher levels of self-perceived information were associated with a greater likelihood of having undergone orthodontic treatment (OR = 0.75, 95% CI: 0.59–0.96, p = 0.020). Income and area of residence were not significantly associated with treatment initiation. However, respondents with lower income levels were significantly more likely to perceive treatment cost as a barrier to orthodontic care. Conclusions: Within this surveyed sample, age and self-perceived information level were independently associated with orthodontic treatment initiation. Although income was not associated with treatment uptake, financial cost remained an important perceived barrier, particularly among lower-income respondents. Given the convenience sampling strategy and limited representativeness of the sample, the findings should be interpreted as exploratory and require confirmation in larger population-based studies. Full article

Urban transportation hubs increasingly face spatial homogenization, eroding regional identity and cultural distinctiveness. This study supports perceptions of a cultural sustainability framework that integrates regional semiotics with visual hierarchy theory, transforming high-speed railway stations from generic transit environments into culturally sustainable mobility spaces. Using Qiantang Station as a case study, four regional cultural narratives were extracted and translated into a hierarchical culturally embedded wayfinding system. Following the questionnaire survey, participants with varying travel frequencies and age distributions were purposively selected to participate in the scenario-based perception experiment in order to ensure sample diversity and heterogeneity in mobility experience. A total of 40 participants (N = 40) compared conventional and culturally embedded wayfinding systems. Results indicated that culturally embedded environments significantly enhanced Cultural Sustainability Perception (CSP: M = 4.13 vs. 3.78, p = 0.002, Cohen’s d = 0.74) and reduced spatial recognition time, while Place Identity and Place Dependence showed no significant differences. These findings suggest that culturally embedded wayfinding systems can enhance passengers’ perceptions of cultural sustainability and cultural visibility within transportation environments. However, the study does not directly evaluate perceived support for cultural-information retention outcomes. Full article

Background/Objectives: Artificial intelligence (AI) holds significant potential to enhance diagnostic support and access to dermatological care; however, its adoption depends on public trust and acceptance. This study aimed to assess knowledge, attitudes, and acceptance of dermatological AI among Saudi adults, and to identify factors associated with adoption, trust, and preferred system characteristics. Methods: A nationwide cross-sectional online survey was conducted among 668 Saudi adults (≥18 years) between 21 May and 5 June 2025, using convenience and snowball sampling via social media platforms (WhatsApp, Snapchat, Twitter/X, and Telegram). The questionnaire captured demographics, attitudes toward AI (20-item Likert scale), and perceived importance of six AI system features. Data were analyzed using descriptive statistics, one-way ANOVA, and binary logistic regression. The study was approved by the Institutional Review Board of King Faisal University (Approval No. KFU-REC-2025-MAY-ETHICS3443, approval date 19 May 2025). Results: The mean overall AI attitude orientation score was 74.48 ± 10.20 (Cronbach’s α = 0.868), reflecting moderately positive but conditional attitudes toward dermatological AI. Participants strongly preferred physician-supervised AI over fully autonomous systems, with medical oversight receiving the highest agreement (mean 4.27 ± 0.87). Privacy protection and diagnostic accuracy were rated as the most important system features. Age was significantly associated with the overall AI attitude orientation score (p = 0.009), with younger participants demonstrating more favorable orientations. Interest in technology showed the strongest association with both AI attitude orientation and perceived importance (p < 0.001). No demographic variable independently predicted high intention to use AI in multivariate analysis. Conclusions: Saudi adults generally exhibit favorable yet cautious attitudes toward dermatological AI. Implementation strategies should prioritize physician oversight, transparency, data privacy, and culturally responsive design to support responsible integration into clinical practice. Full article

Traditional shellfish harvesting plays a crucial role in food security, local livelihoods and the preservation of cultural heritage in coastal communities. This study examined environmental, socioeconomic and circular economy perceptions associated with the artisanal fishery of the “black chinese” snail (Hexaplex nigritus) in the Navachiste Lagoon system, located in the south-eastern Gulf of California. A quantitative, exploratory–descriptive approach was employed using a structured Likert-scale questionnaire administered to 225 fishers. Four analytical dimensions were evaluated: environmental perception, personal-family-social, economic, and circular economy perception. Given the multidimensional nature of the questionnaire, the results were interpreted through item-level response patterns. An exploratory hierarchical cluster analysis using Ward’s method suggested greater similarity between environmental and economic perception profiles, without establishing a definitive relationship. The descriptive results indicated moderate environmental concern ($\overline{\mathrm{x}}$ = 3.12), high sociocultural value ($\overline{\mathrm{x}}$ = 4.49), a negative economic perception ($\overline{\mathrm{x}}$ = 2.32) associated with low income and dependence on intermediaries, and limited adoption of circular economy practices ($\overline{\mathrm{x}}$ = 1.36). It is concluded that, despite its cultural importance, surveyed fishers perceive that the fishery faces environmental pressures and economic constraints and shows an almost total lack of integration of circular economy practices. These findings underscore the potential importance of developing comprehensive policies to promote sustainable management, strengthen marketing, and foster a circular economy for the H. nigritus fishery with the aim of contributing to its long-term sustainability in the region. Full article

Against the backdrop of growing attention to sustainable development in higher education, the widespread application of artificial intelligence (AI) technologies has made the relationship between university students’ AI literacy and innovative behaviour an important issue. To examine this relationship and its underlying psychological mechanisms, this study developed a moderated serial mediation model based on the componential theory of creativity and conservation of resources theory. A questionnaire survey was conducted with 470 university students using measures of AI literacy, AI trust, AI self-efficacy, AI anxiety, and innovative behaviour. The results showed that: (1) AI literacy was significantly and positively associated with university students’ innovative behaviour; (2) AI self-efficacy mediated this relationship, and AI trust and AI self-efficacy jointly formed a serial mediating pathway, whereas the independent mediating effect of AI trust was not significant; and (3) AI anxiety partially moderated the serial mediation model. This study contributes to a better understanding of the psychological mechanisms linking university students’ AI literacy and innovative behaviour in the context of sustainable development in higher education. It also provides theoretical insights and empirical evidence for AI literacy education, student support services, and the cultivation of innovative capacity in universities. Full article

Background: Driven by Vision 2030, Saudi Arabia is rapidly integrating Artificial Intelligence into its healthcare ecosystem. This study investigates the patterns, predictors, and sociodemographic determinants of AI reliance and dependence in healthcare decision making, focusing on how trust influences the shift toward personalized digital diagnosis. Methods: A cross-sectional study was conducted with 627 adults in Saudi Arabia using convenience sampling. Data collected via online questionnaires were analyzed using JMP student edition version 18 software to evaluate user interaction with symptom checkers, wearables, and generative AI. A multidimensional framework assessed how trust and dependence influence health-seeking behaviors. Results: The findings reveal high AI engagement, with 63.7% of respondents using AI tools weekly. Conversational AI and LLMs are the dominant interfaces (92.2%), primarily serving as “gatekeepers” for personalized diagnosis (71.6%) and treatment suggestions (76.9%) before formal consultations. While gender significantly impacts reliance (p = 0.0037), trust was identified as the only significant predictor of overall engagement (p < 0.0001). Notably, age, education, and income had no statistical impact (p > 0.05), indicating uniform adoption across groups. Conclusions: For surveyed cohorts, trust is the primary determinant of AI reliance, overriding traditional demographic factors. Fostering user trust is essential for the successful implementation of AI-driven personalized healthcare solutions. Full article

Rapid urbanization has intensified transportation challenges in many metropolitan areas, increasing reliance on private vehicles and contributing to congestion and environmental concerns. Although transit-oriented development strategies aim to promote sustainable mobility by improving public transport accessibility, the behavioral mechanisms linking built environment characteristics to travel behavior remain insufficiently explored. This study examines the influence of transit accessibility (TA) and parking availability on mode choice preference and travel behavior. A structured questionnaire survey was conducted, and the data were analyzed using covariance-based structural equation modeling after validating the measurement constructs through exploratory and confirmatory factor analyses. The results indicate that TA positively influences mode choice preferences, whereas parking availability negatively affects them. Furthermore, mode choice preferences significantly influence travel behavior, underscoring their mediating role between built environment factors and mobility outcomes. These findings provide empirical insights for urban planners seeking to promote sustainable transportation through enhanced TA and effective parking management strategies. Full article

Background/Objectives: Contemporary periodontal therapy is increasingly guided by evidence-based clinical protocols, particularly the European Federation of Periodontology (EFP) S3 Clinical Practice Guidelines. The present study aimed to assess dentists’ perceptions regarding modern periodontal therapy and to perform a preliminary psychometric evaluation of a newly developed questionnaire. Methods: A cross-sectional questionnaire-based study was conducted among 109 dental practitioners. The questionnaire evaluated perceptions regarding non-surgical periodontal therapy, surgical periodontal therapy, and the comparative role of both therapeutic approaches. Descriptive statistical analysis, internal consistency analysis using Cronbach’s Alpha, Intraclass Correlation Coefficient (ICC), repeated measures ANOVA, and exploratory factor analysis (Principal Component Analysis—PCA) with Varimax rotation were performed to evaluate the psychometric properties of the instrument. Results: The questionnaire demonstrated good internal consistency, with Cronbach’s Alpha values ranging from 0.77 to 0.86. ICC analysis confirmed satisfactory reliability. Respondents showed favorable attitudes toward evidence-based periodontal management, supporting non-surgical therapy as first-line treatment and the staged integration of surgical approaches in complex cases. Exploratory factor analysis identified a coherent factorial structure, with four components explaining 73.94% of the total variance. Conclusions: The questionnaire showed good psychometric properties, supporting its potential utility as a reliable and useful instrument for evaluating professional attitudes and clinical decision-making in periodontology. Full article