Search Results (49,215)

Hand hygiene is a cornerstone of infection prevention, yet adherence often declines once public health emergencies subside. This study examines post-pandemic hand hygiene practices and knowledge among public health trainees. We conducted a cross-sectional study of graduate students (N = 93) at a U.S. School of Public Health between May and October 2025. Participants completed a self-administered questionnaire assessing knowledge, self-reported practices, and demographics, with associations analyzed using chi-square tests. Results indicated that while 65.6% of participants possessed good knowledge (mean score 6.92 ± 1.92), only 23.7% met the criteria for good hand hygiene practice. Knowledge level was not associated with practice (p = 0.631). In contrast, sex was strongly associated with behavior: 34.4% of females reported good practice compared with 3.1% of males (p = 0.0016). Furthermore, adherence in high-risk situations was low, with only 7% reporting handwashing after coughing or sneezing. In conclusion, hand hygiene knowledge did not translate into consistent preventive behavior among these trainees. The observed differences by sex suggest that post-pandemic interventions should prioritize behavioral and social determinants rather than relying on information-based strategies alone. Full article

Background: Endometriosis is a chronic condition associated with substantial healthcare costs, diagnostic delays and long-term impairment in quality of life. Despite the recognized economic burden, patient-reported financial distress remains insufficiently studied. The aim of this study was to adapt and validate the Polish version of the Comprehensive Score for Financial Toxicity (COST-FACIT) for use in women with endometriosis, as well as to examine demographic and clinical factors associated with financial toxicity. Methods: A cross-sectional study was conducted among Polish women with endometriosis using an online survey. The COST-FACIT was adapted following standard forward–backward translation procedures, with FACIT approval. Psychometric evaluation included internal consistency, construct validity, convergent validity with the Financial Well-Being Scale, and test–retest reliability. Exploratory and confirmatory factor analyses were performed, and multivariable models were used to identify factors associated with financial toxicity. Results: The adapted scale demonstrated good psychometric properties, with excellent internal consistency (Cronbach’s α = 0.92; McDonald’s ω = 0.92) and strong test–retest reliability (r = 0.87). Exploratory factor analysis supported a two-factor structure of the instrument. COST-FACIT scores were strongly correlated with financial well-being (r = 0.78). Higher education, stable employment and higher income were associated with better financial well-being, whereas longer symptom duration, greater distance to care and higher healthcare expenditures were associated with worse scores. Conclusions: The Polish COST-FACIT demonstrated good psychometric properties and may serve as a useful instrument for assessing financial toxicity in women with endometriosis. The results highlight the financial burden of the disease and support the use of patient-reported measures to identify individuals at risk of financial distress and reduced quality of life. This tool may facilitate clinical research and improve patient-centered care. Full article

Recent research highlights the importance of effective teaching methodologies to enhance scientific learning from the earliest years of schooling. The present study investigates the effects of the Spaced Learning (SL) methodology in science education in Italian primary schools, with particular attention to scientific knowledge and students’ scientific reasoning skills. The study involved 401 third- and fourth-grade pupils (aged 8–11) from three primary schools in Palermo, Italy, during the 2024/2025 school year. A quasi-experimental design was adopted, with classes assigned to an experimental group that adopted SL or to a control group that followed traditional teaching. The intervention lasted seven months and was supported by continuous teacher training and collaboration with university researchers. The data were collected through a pre-test/post-test questionnaire developed and validated by experts in physics education. The tool assessed the students’ general scientific reasoning skills through multiple-choice items inserted in everyday life contexts. Descriptive statistics were calculated and between-group comparisons were made by Student’s t-test or Welch’s t-test when the assumption of homogeneity of variances was not met. The results indicate that students exposed to the SL methodology achieved higher post-test scores than those who received traditional education, suggesting a positive effect of time-distributed, movement-integrated learning on science learning outcomes. Such results support the effectiveness of SL as a promising teaching approach to promote meaningful and lasting scientific learning in primary school. Full article

Strongyloides stercoralis (S. stercoralis) is an important soil-transmitted helminth that infests over 600 million people worldwide. However, data on its seroprevalence in remote regions, such as Thailand’s island areas, remain limited. This study examined the seroprevalence and associated risk factors of anti-Strongyloides spp. IgG seropositivity among primary school children in Koh Yao, an island in southern Thailand. A total of 351 primary school children (156 males and 195 females) were included. The seroprevalence of anti-Strongyloides spp. IgG was determined using the Strongyloides-specific IgG antibodies ELISA, and risk factor data were collected through a questionnaire. Hematological parameters were also analyzed. Univariate and multivariate logistic regression analyses were used to assess associations between risk factors and anti-Strongyloides spp. IgG seropositivity. The seroprevalence of anti-Strongyloides spp. IgG was 3.7% (13/351 participants). Analysis of the risk factors revealed that participants who drank filtered water exhibited lower odds of anti-Strongyloides spp. IgG seropositivity compared to those who drank tap or rainwater (AOR = 0.21, 95% CI 0.05–0.95, p = 0.043). However, due to the small number of seropositive cases, this association is hypothesis-generating and likely serves as a proxy for better household hygiene rather than a direct protective factor. This study is the first report on anti-Strongyloides spp. IgG seropositivity among primary school children in Koh Yao, southern Thailand, demonstrating a low seropositivity rate in this population. These findings provide location-specific information on modifiable risk behaviors, aiding in developing more effective control and prevention strategies for anti-Strongyloides spp. IgG seropositivity in Thailand’s island area. Full article

Background: Sexual health is a fundamental pillar of well-being during the perinatal period. However, many studies suffer from scoring bias associated with zero values by failing to distinguish between women who are sexually inactive and those with physiological dysfunction. This study aimed to identify the distinct sociodemographic and psychological determinants of sexual inactivity versus sexual dysfunction quality in a Romanian perinatal cohort. Methods: An observational, cross-sectional study was conducted with 100 women (52% sexually active, 48% inactive). Participants were evaluated using the Female Sexual Function Index (FSFI), Patient Health Questionnaire-9 (PHQ-9), RSES (Rosenberg Self-Esteem Scale), and Generalized Anxiety Disorder-7 (GAD-7). Data were analyzed using binary logistic regression for activity status and multiple linear regression for functional quality. Results: Among sexually active women, 84.6% met the clinical criteria for sexual dysfunction (median FSFI = 21.6). Binary logistic regression revealed that self-esteem (RSES) was the sole independent predictor of sexual activity status (aOR = 1.144; 95% CI: 1.028–1.217, p = 0.016). Conversely, multiple linear regression showed that depression (PHQ-9) was the only significant independent predictor of functional quality (B = −0.73, p = 0.006). Maternal age, residence, and obstetric history did not significantly predict either outcome. Conclusions: Based on the findings of our preliminary, exploratory study, we propose a conceptual interpretation, framing perinatal sexuality as a potential two-stage process, where self-esteem appears to serve as a primary behavioral barrier for the resumption of intimacy, while depression serves as the primary disruptor of functional quality. Clinical interventions may benefit from moving beyond physical recovery to include psychological screening for body image and mood disorders to restore sexual quality of life. Full article

Background: Youth soccer players are exposed to repeated unilateral loading during a period of rapid growth and neuromuscular maturation. These demands may contribute to postural deviations and inter-limb functional asymmetries that can influence movement control and mechanical efficiency. This study protocol aims to establish a standardized multimodal framework for assessing postural alignment, postural control, lower limb mechanical output, ankle dorsiflexion strength, support-limb neuromuscular activation, and contextual training and recovery variables in licensed youth soccer players aged 13 to 17 years. Methods: This prospective observational study will include 75 male youth soccer players recruited from S.C. Fotbal Club Ripensia Timișoara S.A. The primary outcome is the inter-limb asymmetry index derived from unilateral countermovement jump performance. Secondary outcomes include postural alignment, balance, bilateral jump performance, ankle dorsiflexion strength, and support limb electromyographic activity during the instep kick. Participants will complete a clinical evaluation questionnaire, including demographic, training, and recovery variables. Assessments will be conducted using the GaitON system, Kinvent K-Delta force platforms, K-Myo surface electromyography, and K-Pull dynamometry, before and after a regular training session. Biological maturation will be estimated using the Mirwald maturity offset method. Expected Results: The protocol will allow characterization of inter-limb asymmetries across postural, balance, jump, and electromyographic parameters. Conclusions: This protocol aims to provide a practical and standardized model for functional screening in youth soccer players. Full article

This study addresses second-home ownership not merely as a form of tourism accommodation or real estate investment, but as a home-building process intersecting with local life, belonging, daily practices, and sustainable destination governance. While the economic, environmental, and community impacts of second-homes have been extensively discussed in the literature, how individuals perceive their primary and secondary homes differently in terms of the bodily, material, vibrant, imaginary, and emotional dimensions of home has been examined in a limited number of studies. This research analyzes paired data obtained through a two-stage online questionnaire from 223 British participants who own a secondary home in the Mugla–Ortaca region and a primary home in the United Kingdom. The 18-item Home Scale was used as the measurement tool. Confirmatory factor analysis, reliability–validity analyses, measurement invariance, and paired-samples t-tests were applied. The findings show that the bodily home difference was not statistically significant at the conventional 0.05 threshold, whereas primary-home scores were significantly higher in the material, vibrant, imaginary, and emotional home dimensions. The small to small-medium effect sizes suggest that the results should be interpreted cautiously as an asymmetrical home-building process rather than as evidence of a hierarchical superiority of the primary home. The study proposes a planning approach that does not view second home owners as merely transient consumers in sustainable coastal–rural destinations, but rather considers social sustainability, service planning, seasonality management, and local community engagement channels together. Full article

Physical literacy is widely conceptualized as a holistic, multidimensional construct that encompasses the affective, physical, cognitive, and social domains. However, the assessment in early childhood education (ECE) contexts is conceptually fragmented and inconsistent in practice. This study aims to develop a practice-informed physical literacy assessment model based on practitioners’ perspectives and empirical patterns. A quantitative, cross-sectional survey was conducted with 324 practitioners working with children aged 1.5–7 years in various ECE contexts in Latvia. The questionnaire examined three dimensions of assessment practice: (1) physical literacy domains and components, (2) assessment processes (functions, methods, forms, and documentation), and (3) perceptions of assessment quality (validity, reliability, and usability). Descriptive statistics and nonparametric analyses were used to identify dominant patterns. The findings suggest that all four domains of physical literacy are included in assessments of early childhood educational contexts. However, the components of these domains are not consistently defined. More observable components are assessed more consistently, while less visible components are more frequently interpreted within specific pedagogical contexts. Assessment is predominantly formative, process-oriented, and embedded in play-based activities typical of early childhood education (ECE) contexts, with limited use of diagnostic approaches. Based on these findings, we propose a practice-informed assessment model. This model is conceptualized as a structured framework of content, assessment processes, and quality conditions applicable within early childhood education contexts. In this model, assessment criteria function as an interpretive filter that shapes the selection of methods and the interpretation of content. This positions assessment as a dynamic, context-dependent process mediated by the early childhood practitioners. These findings suggest the need to transition from standardized approaches to more context-sensitive and theoretically grounded assessment practices in early childhood education contexts. This framework has the potential to enhance the alignment between physical literacy conceptualizations and their subsequent implementation in practice. Full article

Urban planning increasingly depends on methods capable of capturing citizen perspectives in forms that are both inclusive and analytically useful for decision-making. Conventional participation mechanisms, such as public meetings, paper questionnaires, and online platforms, often suffer from low reach, strong self-selection effects, and weak suitability for structured comparative analysis. This paper presents XRCity, a decision support system that combines extended reality, conversational artificial intelligence, and a planner-side backend to support participatory urban planning in public spaces. The system is centered on Olivia, a life-sized virtual assistant deployed on outdoor interactive screens, and on a backend environment that enables planners to prepare knowledge resources, configure interaction scripts, validate conversational behavior, process transcripts, and analyze elicited opinions. The contribution of the paper is not just the presentation of an XR interface, but the description and validation of a complete decision-support pipeline that connects campaign design, citizen interaction, opinion structuring, and planner-side analytics. The system was validated through real-world deployment in Torres Vedras, Portugal. Across more than 250 interactions and over 740 min of conversation, 191 usable sessions were analyzed, showing an average of 6.7 messages per user and 2.8 min per interaction. Of these sessions, 14.7% produced at least one structured response to an urban planning question, exceeding the project target of 10%. These results indicate the operational feasibility of using public-space conversational XR to elicit analyzable planning input, while a formal validation of the opinion-matching step remains future work. Full article

Introduction: The work-related quality of life affects employee satisfaction and organizational effectiveness, with a direct impact on the quality of healthcare. This study aims to investigate the work-related quality of life (WRQoL) among nurses in tertiary healthcare, as perceived by the nurses themselves, in relation to their demographic and professional characteristics. At the same time, it seeks to highlight the way in which the individual dimensions of WRQoL influence their sexual and mental health. Materials and Methods: A descriptive cross-sectional study was conducted in 2023 in a General Hospital in Greece. Data were collected using structured questionnaires assessing sociodemo-graphic and occupational characteristics, WRQoL, mental health (Depression, Anxiety and Stress Scale—DASS-21), and female sexual function (Female Sexual Function Index—FSFI-19). Pearson correlation analysis and multiple linear regression analysis were performed. The regression model was adjusted for age, marital status, number of children, and work experience. Results: The results demonstrated a significant negative association between depression and sexual function (β = −0.388, p = 0.029), while stress was positively associated with sexual function (β = 0.371, p = 0.038). The overall regression model was statistically significant (p = 0.001), explaining 18.6% of the variance in sexual function. Conclusions: The findings highlight the close interrelationship between work-related quality of life, mental health, and sexual function among nurses. Poorer psychological well-being was associated with reduced sexual function, emphasizing the impact of occupational and emotional burden on nurses’ overall health. These results underline the importance of supportive workplace environments and targeted interventions to promote mental and sexual well-being among healthcare professionals. Full article

Background/Objectives: Whether habitual dietary omega-3 fatty acid intake is reflected in circulating biomarkers of atrial fibrillation (AF)-related pathways is unclear. We assessed whether usual dietary intake of n-3 fatty acids—considered as total, marine-derived, or non-marine-derived—was associated with the trajectories of five serum markers that reflect AF-related mechanistic pathways [N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), high-sensitivity troponin T (hs-TnT), high-sensitivity C-reactive protein (CRP), the C-terminal propeptide of type-I procollagen (PICP), and 3-nitrotyrosine (3-NT)] over 5 years of follow-up. Methods: In 510 participants of the PREDIMED-Plus trial (older Spanish adults with metabolic syndrome), we measured plasma NT-pro-BNP, hs-TnT, CRP, PICP, and 3-NT at baseline and after 3 and 5 years. Energy-adjusted omega-3 intake was assessed with a validated 143-item food-frequency questionnaire. Cross-sectional and 5-year longitudinal associations according to tertiles of omega-3 fatty acid intake were estimated with linear regression and mixed-effects models. Results: Median total omega-3 intake was 2.0 g/day. Total omega-3 intake was not associated with any biomarker, neither cross-sectionally nor longitudinally. Marine omega-3 was directly associated cross-sectionally with 3-NT (highest vs. lowest tertile +28.4%, 95% CI 5.5 to 56.2; p-trend = 0.014) but not longitudinally. Moderate baseline non-marine omega-3 fatty acid intake was associated with a decrease in PICP after 5 years of follow-up. Conclusions: Overall, habitual total omega-3 fatty acid intake was not associated with circulating AF-related pathways. The sporadic association between marine omega-3 fatty acid intake and 3-NT in the cross-sectional assessment and the isolated non-linear association between baseline non-marine omega-3 fatty acid intake and PICP after 5 years warrant further investigation. Full article

Background: Tinnitus is a common and potentially distressing phenomenon for which no broadly effective curative treatment exists. Self-management skills and empowerment are crucial for coping with chronic conditions, but empirical studies investigating the association of these on individuals burdened by tinnitus are scarce. The primary aim of this cross-sectional study was to investigate the association between the use of an online self-help platform for people with tinnitus and self-perceptions of empowerment, self-management skills, and the cognitive and emotional representations of tinnitus. Methods: One hundred and fifty-two adult participants were recruited from an online self-help platform for people with tinnitus, resulting in a self-selected convenience sample. Self-management skills were assessed using the Patient Assessment of Chronic Illness Care (PACIC) and the Partners in Health Questionnaire. The cognitive and emotional representations of tinnitus were measured with the Illness Perception Questionnaire. Finally, the Empowering Processes and Outcomes Questionnaire was used to evaluate empowerment associated with engagement in the self-help platform. The type and frequency of user activity on the self-help platform were used to explore the relationship between the nature of contributions to the platform and the measured outcomes. Results: The key findings include: (1) The representations of tinnitus were negatively related to their ability to self-manage the condition. (2) The duration of tinnitus did not correlate with improved self-management skills. (3) Comparing those who visited a healthcare provider for their tinnitus with those who did not, we found that treatment adherence was higher among participants with clinical visits. (4) Participants in this study scored lower on all aspects of self-management skills (as measured by the PACIC) compared to patients using primary healthcare services. (5) Participants who actively contributed to the self-help platform by posting scored higher in two empowering processes: helping others and sharing experiences. Conclusions: The present findings suggest that tinnitus self-management skills are independent of tinnitus duration, whereas those skills correlate negatively with illness perception. Further, clinical visits are associated with higher treatment adherence, and active self-help platform use increases feelings related to helping others and shared experiences. Taken together, these results highlight the need for fostering self-management skills and structured peer-to-peer support programs. Because this was a self-selected convenience sample of users of an online tinnitus self-help platform, the findings should be interpreted in light of this recruitment context and not generalized to the broader tinnitus population. Full article

Introduction: Oral health in early childhood is essential. Parents, as the primary caregivers, must possess basic knowledge to achieve optimal oral health status. Objectives: The study aims to assess parents’ knowledge and perspectives on early childhood oral health and to evaluate how nationality and educational attainment influence their preventive habits and dental priorities within a nursery and primary school in the province of Huelva (Spain). Materials and Methods: The sample consisted of 129 parents of children aged 3, 4, and 5 years from the aforementioned educational center. A modified questionnaire, validated by experts in the field, was used as the assessment tool. Results: Nationality and education were key determinants of oral health literacy. Spanish-born guardians reported significantly higher dental attendance for their children compared to foreign-born guardians (97.7% vs. 84.2%; p = 0.030). A profound cultural gap was observed in caries etiology: 71.1% of foreign-born respondents attributed caries to “infections or heredity,” while 98.4% of Spanish-born respondents correctly identified behavioral factors (p < 0.001). Regarding educational attainment, 75% of the high-education group prioritized functional health (posterior sector) compared to only 26.3% in the low-education group (p < 0.001). Additionally, a non-linear gap was found in knowledge of primary tooth complications, with the medium-education group showing the lowest awareness (34.8%; p = 0.047). Full article

Despite the growing participation of women in higher education worldwide, they continue to face persistent challenges in their career advancement, including limited promotion opportunities, underrepresentation in leadership positions, lower research productivity, and unequal access to institutional resources. These challenges are shaped by a range of structural, institutional, and socio-cultural constraints within academia. Understanding these influencing factors is essential for promoting gender equity within universities. This study investigates the factors influencing the career advancement-related challenges experienced by women academics in Jordanian higher education institutions, focusing on career experience, family responsibilities, and organisational support. Grounded in Gendered Organisations Theory, Work-Family Conflict Theory, and Social Support Theory, the study develops and empirically tests an integrated conceptual model. Data were collected through a questionnaire survey of women academics across Jordanian universities. The quantitative data were analysed using Partial Least Squares Structural Equation Modelling (PLS-SEM), while qualitative responses on strategies for overcoming challenges were examined using directed qualitative content analysis. The findings indicate that family responsibilities represent the most influential driver of perceived challenges, highlighting the continuing tension between professional and domestic roles. Career experience is found to reduce perceived challenges, suggesting that accumulated professional capital and institutional familiarity enhance women’s ability to navigate academic environments. Organisational and social support not only directly reduce perceived challenges but also buffer the impact of family responsibilities. Multi-group analysis further reveals differences in the strength of these relationships between teaching-research academics and those occupying leadership roles. The qualitative results identify key strategies for addressing these challenges, including mentoring systems, flexible institutional policies, professional networking, and leadership development initiatives. By integrating structural modelling with qualitative insights, this study advances understanding of the complex dynamics shaping women’s academic careers and provides evidence-based recommendations for fostering more inclusive and supportive higher education environments. Full article

Elderly individuals in rural China are highly vulnerable to extreme weather events and temperature fluctuations due to inadequate infrastructure in the built environment and constrained economic conditions, thereby increasing their health risks. Outdoor spaces represent one of the primary daily activity settings for rural older adults. However, existing research rarely links spatiotemporal patterns of outdoor activities to evidence-based thermal environment optimization, leaving a critical knowledge gap for age-friendly and sustainable rural design. This study focuses on the spatiotemporal differentiation patterns of daily outdoor activities among elderly people aged 60 years and above in rural Xi’an, as well as the optimization of spatial variations in thermal environments. Using on-site interviews, thermal environment measurements, thermal comfort questionnaires, continuous thermal environment monitoring, and machine learning based on random forest, this study drew the following conclusions: (1) outdoor activities in winter were concentrated between 9:00–11:00 and 13:00–17:00, while in summer, they shifted to the morning and evening periods, namely 6:00–9:00 and 17:00–21:00. (2) Models for outdoor clothing adjustment, thermal sensation, and thermal acceptability among elderly residents were established. The calculated neutral temperature was 10.19 °C, with a 90% outdoor thermal acceptability range of 9.6–27.2 °C and an 80% outdoor thermal acceptability range of 6.2–30.6 °C. These findings differ from those documented in regions with distinct climate zones and geographical settings. This discrepancy stems from regional climatic features, lifestyle variations between urban and rural older adults, and differences in the thermal environment quality of elderly-oriented outdoor activity spaces. (3) In winter, the acceptable period of the Universal Thermal Climate Index (UTCI) at south-facing entrances (10:30–16:30) was significantly longer than that in the courtyard (13:30–14:00). In summer, the comfortable period in the courtyard (before 10:00 and after 20:00) was longer than that at north-facing entrances (before 09:00). A random forest model for thermal sensation was established, and the relative importance of each parameter influencing thermal sensation was analyzed. On this basis, priority improvement pathways and strategies for the thermal environment, as well as suggestions for the subjective adaptive behaviors of elderly residents, were proposed. The research results of this study can provide technical solutions for age-friendly thermal environment design in rural areas, thereby safeguarding the comfort, health, and social well-being of the elderly population in rural areas. Full article