Search Results (324)

Background: Cervical cancer poses a threat to the health of women globally. Adolescent girls are the primary target population for HPV vaccination, and guardians’ attitude towards the HPV vaccine plays a significant role in determining the vaccination status among adolescent girls. Objectives: This study aimed to explore the factors influencing guardians’ HPV vaccine acceptance for their girls and provide clues for the development of health intervention strategies. Methods: Combining the health belief model as a theoretical framework, a questionnaire-based survey was conducted. A total of 2157 adolescent girls and their guardians were recruited. The multivariable logistic model was applied to explore associated factors. Results: The guardians had a high HPV vaccine acceptance rate (86.7%) for their girls, and they demonstrated a relatively good level of awareness regarding HPV and HPV vaccines. Factors influencing guardians’ HPV vaccine acceptance for girls included guardians’ education background (OR = 0.57, 95%CI = 0.37–0.87), family income (OR = 1.94, 95%CI = 1.14–3.32), risk of HPV infection (OR = 3.15, 95%CI = 1.40–7.10) or importance of the HPV vaccine for their girls (OR = 6.70, 95%CI = 1.61–27.83), vaccination status surrounding them (OR = 2.03, 95%CI = 1.41–2.92), awareness of negative information about HPV vaccines (OR = 0.59, 95%CI = 0.43–0.82), and recommendations from medical staff (OR = 2.32, 95%CI = 1.65–3.25). Also, guardians preferred to get digital information on vaccines via government or CDC platforms, WeChat platforms, and medical knowledge platforms. Conclusions: Though HPV vaccine willingness was high among Chinese guardians, they preferred to vaccinate their daughters at the age of 17–18 years, later than WHO’s recommended optimal age period (9–14 years old), coupled with safety concerns. Future work should be conducted based on these findings to explore digital intervention effects on girls’ vaccination compliance. Full article

In an era where digitalization shapes economic and social landscapes, the intersection of digital skills, ethics, and integrity plays a crucial role in understanding the vulnerability of youth classified as NEET (Not in Education, Employment, or Training). This study explores how risky internet use and digital skill gaps contribute to socio-economic exclusion, integrating a multivariate and spatial approach to assess regional disparities in Europe. This study adopts a systems thinking perspective to explore digital exclusion as an emergent outcome of multiple interrelated subsystems. The research employs logistic regression, Principal Component Analysis (PCA) with Promax rotation, and Geographic Information Systems (GIS) to examine the impact of digital behaviors on NEET status. Using Eurostat data aggregated at the country level for the period (2000–2023) across 28 European countries, this study evaluates 24 digital indicators covering social media usage, instant messaging, daily internet access, data protection awareness, and digital literacy levels. The findings reveal that low digital skills significantly increase the likelihood of being NEET, while excessive social media and internet use show mixed effects depending on socio-economic context. A strong negative correlation between digital security practices and NEET status suggests that youths with a higher awareness of online risks are less prone to socio-economic exclusion. The GIS analysis highlights regional disparities, where countries with limited digital access and lower literacy levels exhibit higher NEET rates. Digital exclusion is not merely a technological issue but a multidimensional socio-economic challenge. To reduce the NEET rate, policies must focus on enhancing digital skills, fostering online security awareness, and addressing regional disparities. Integrating GIS methods allows for the identification of territorial clusters with heightened digital vulnerabilities, guiding targeted interventions for improving youth employability in the digital economy. Full article

Purpose: Exercise is recommended for survivors of breast cancer to alleviate adverse reactions and reduce the psychological burden. In recent years, however, environmental factors (e.g., pandemics and climate change) have made it difficult to exercise outdoors. Therefore, this study focused on the COVID-19 pandemic in Japan and evaluated the relationship between changes in physical activity (PA) and mental and physical health in breast cancer survivors. Methods: A questionnaire survey was conducted among 345 outpatient female breast cancer survivors aged between 29 and 69 years. The questionnaire was based on the International Physical Activity Questionnaire, the Patient Health Questionnaire-9, the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire, and the Fear of COVID-19 Scale and included patient characteristics, changes in PA during pandemic restrictions, and needs for exercise support. The analysis categorized PA changes into two groups according to activity levels. The relationship between changes in PA and physical and mental health was evaluated using logistic regression analysis. Results: Patients with decreased PA accounted for 65.5% of the study population. Regardless of their activity level, these patients were aware of an increased susceptibility to COVID-19, showed a fear of the disease and a tendency for depression, and reported low life satisfaction and declined physical function. Of the patients who stopped exercising, 82.9% reported a decline in PA. Compared with those who had never exercised, those who stopped exercising saw their risk of depression increase by 15.6%. There was a high demand for personalized exercise support from healthcare professionals. Conclusions: Regardless of their activity level, decreasing PA during the pandemic decreased mental health and physical function in breast cancer survivors. There was a higher risk of depression among patients who stopped exercising. Because it is possible that similar situations may occur in the future, interventions by healthcare professionals must be considered in order to continue exercise. Full article

Certain industries will bear a disproportionate share of the burden of climate change. Climate change risk perceptions can impact workers’ mental health and well-being; increased climate change risk perceptions are also associated with more favourable adaptive attitudes. It is, therefore, important to understand whether climate risk perceptions differ across workers between industries. We conducted an online survey of British Columbians (16+) in 2021 using social media advertisements. Participants rated how likely they believed their industry (Natural Resources, Science, Art and Recreation, Education/Law/Government, Health, Management/Business, Manufacturing, Sales, Trades) would be affected by climate change (on a scale from “Very Unlikely” to “Very Likely”). Ordinal logistic regression examined the association between occupational category and perceived industry vulnerability, adjusting for socio-demographic factors. Among 877 participants, 66.1% of Natural Resources workers perceived it was very/somewhat likely that climate change would impact their industry; only those in Science (78.3%) and Art and Recreation (71.4%) occupations had higher percentages. In the adjusted model, compared to Natural Resources workers, respondents in other occupations, including those in Art and Recreation, Education/Law/Government, Management/Business, Manufacturing, Sales, and Trades, perceived significantly lower risk of climate change-related industry impacts. Industry-specific interventions are needed to increase awareness of and readiness for climate adaptation. Policymakers and industry leaders should prioritize sectoral differences when designing interventions to support climate resilience in the workforce. Full article

Background/Objectives: The use of artificial sweeteners (AS) is increasing globally despite growing evidence suggesting potential health risks. This study investigates the sociodemographic and health-related factors associated with AS use in the Hungarian population. Methods: We conducted a cross-sectional analysis using data from the 2019 European Health Interview Survey (EHIS), comprising 5603 participants. AS users were identified based on self-reported use of AS. Logistic regression models were used to examine associations between regular AS use and demographic, socioeconomic, and health variables. Interaction terms were included to explore potential effect modification. Results: AS use was reported by 20.1% of participants. Older adults, individuals with overweight or obesity, and those reporting poorer self-perceived health were more likely to use AS. AS use was also higher among individuals in lower and middle-income quintiles. Interaction analyses revealed that overweight and obese individuals with the lowest income, as well as older adults in poor health, were particularly likely to use AS. Conclusions: The findings highlight disparities in AS use across age, income, BMI, and health status, raising concerns about the public’s perception of AS as a healthier alternative. Public health strategies should focus on increasing awareness of the potential risks and encourage evidence-based dietary choices. Full article

Introduction: Urinary tract infections (UTIs) remain a significant public health issue worldwide, particularly affecting the geriatric population with increased morbidity and mortality. Aging-related immune changes, comorbidities, and urogenital abnormalities contribute to the higher incidence and complexity of UTIs in elderly patients. Antimicrobial resistance, especially extended-spectrum beta-lactamase (ESBL) production and carbapenem resistance, poses a major challenge in managing UTIs in this group. Methods: This retrospective, multicenter study included 776 patients aged 65 and older, hospitalized with a diagnosis of urinary tract infection between January 2019 and August 2024. Clinical, laboratory, and microbiological data were collected and analyzed. Urine samples were obtained under sterile conditions and pathogens identified using conventional and automated systems. Antibiotic susceptibility testing was performed according to CLSI standards. Logistic regression analyses were conducted to identify factors associated with ESBL production, carbapenem resistance, and mortality. Results: Among the patients, the median age was 78.9 years, with 45.5% female. ESBL production was detected in 56.8% of E. coli isolates and carbapenem resistance in 1.2%. Klebsiella species exhibited higher carbapenem resistance (37.8%). Independent predictors of ESBL production included the presence of urogenital cancer and antibiotic use within the past three months. Carbapenem resistance was associated with recent hospitalization, absence of kidney stones, and infection with non-E. coli pathogens. Mortality was independently associated with intensive care admission at presentation, altered mental status, Gram-positive infections, and comorbidities such as chronic obstructive pulmonary disease and urinary incontinence. Discussion: Our findings suggest that urinary pathogens and resistance patterns in elderly patients are similar to those in younger adults reported in the literature, highlighting the need for age-specific awareness in empiric therapy. The identification of risk factors for multidrug-resistant organisms emphasizes the importance of targeted antibiotic stewardship, especially in high-risk geriatric populations. Multicenter data contribute to regional understanding of resistance trends, aiding clinicians in optimizing management strategies for elderly patients with UTIs. Conclusions: This study highlights that E. coli and Klebsiella species are the primary causes of UTIs in the elderly, with resistance patterns similar to those seen in younger adults. The findings also contribute important data on risk factors for ESBL production and carbapenem resistance, supported by a robust patient sample. Full article

New York State (NYS) has experienced warming outpacing the national average, and heat events are increasing. This case-crossover study uses conditional logistic regression to estimate how maximum heat index affects heat-related illness across temporal, demographic, and spatial groups in NYS, from May to September, 2008–2019. The highest risks were in May (Relative Risk (RR) = 1.81, CI: 1.72, 1.90) and August (RR = 1.86, CI: 1.79, 1.94). Older adults, especially those aged 85 and above, are at greatest risk (RR = 1.83, CI: 1.71, 1.96). The Southern Tier climate region had a higher risk (RR = 1.93, CI: 1.80, 2.07) than several other regions. Overall, similar risk between rural and urban NYS was observed. Rural non-Hispanic Black (RR = 2.38, CI: 1.78, 3.19) populations had a higher risk than their urban counterparts. This study was innovative for NYS, providing a deeper understanding of heat–health risks to vulnerable sub-groups. This can assist with facilitating targeted interventions and public health messaging during the periods of highest risk, such as promoting awareness of cooling centers and air-conditioning benefits. Full article

Background: Worldwide, the awareness about childhood obesity as a public health concern is increasing, particularly in developing countries like Pakistan. Obesity during early childhood may persist into later ages, increasing the risk of chronic illnesses such as diabetes and hypertension. Objective: The aim of this study was to examine the relationship of different types of food groups with obesity among children with normal and stunted growth trajectories in Pakistan. Methods: This cross-sectional study conducted a secondary analysis of Pakistan Demographic and Health Surveys (PDHSs) conducted in the years 2012–2013 and 2017–2018. Data of 1230 healthy and obese children with either normal or stunted growth were analysed after excluding those who were aged below six months, wasted, underweight, or had missing anthropometric or dietary data. The relationship of different food groups with obesity among the children with normal and stunted growth was analysed by bivariate logistic regression. Results: The prevalence of paediatric obesity dropped from 7.3% in 2012–2013 to 2.4% in 2017–2018. However, the coexistence of stunting with obesity—termed the nutritional paradox—slightly increased from 2.8% in 2012–2013 to 3% in 2017–2018. Among the different food groups, the continuation of breastmilk was associated with lowering the odds of obesity by 69% (25% to 88%) among children with normal growth. Conversely, among children with stunted growth, the continuation of breastmilk was associated with an increase in the odds of obesity by 3.71 (1.08 to 12.62) times. Conclusion: Despite the 4.9% reduction in paediatric obesity, cases of the nutritional paradox are still escalating in Pakistan. This reflects an urgent need for targeted nutritional interventions to mitigate the impact of obesogenic diets and reduce the prevalence of childhood obesity in Pakistan. Full article

Background/Objectives: Injury prevention programs (IPPs) are evidence-based interventions that reduce musculoskeletal injuries in youth sports. Despite their proven benefits, the adoption of IPPs by coaches remains limited. This study aimed to evaluate the awareness, usage, and perceptions of IPPs among youth sports coaches in Poland and to identify factors associated with their implementation. Methods: A cross-sectional study was conducted using a web-based survey tailored to youth sports coaches in Poland. Coaches of athletes aged 9–17 were recruited through targeted outreach to clubs and professional networks. The survey assessed IPP awareness, implementation, perceptions, and sources of information. Statistical analyses included chi-square tests, non-parametric comparisons, Firth’s logistic regression, and cluster profiling. Results: Only 54.6% of coaches (59 out of 108) were aware of IPPs, and among them, just 47.5% reported using them. No significant associations were found between IPP use and demographic variables such as gender, sport, or place of residence. Coaches who were aware of IPPs were significantly younger than those who were unaware (p = 0.029). The information source was the strongest predictor of IPP implementation: coaches trained via formal courses were over 20 times more likely to use IPPs compared to those learning from peers (OR = 20.4, p < 0.001). While coaches generally perceived IPPs as beneficial for fitness and recovery, 28.6% expressed doubts about their effectiveness in reducing injury risk. Conclusions: Despite broadly positive beliefs, only 47.5% of coaches who were aware of IPPs reported using them. Formal training significantly enhances the likelihood of adoption. These findings emphasize the need for structured educational efforts and improved dissemination strategies to promote evidence-based injury prevention in youth sports settings. Full article

Information asymmetry leads to farmers’ opportunistic behavior of disobeying pest control regulations in certified vegetable areas, but the improvement of farmers’ digital literacy has become an important means to break through the constrained dilemma of pest control information and change farmers’ pest control behaviors. Based on survey data from certified vegetable areas of Shaanxi, Gansu, and Ningxia provinces in China, this study used Heckman two-stage model to analyze the impact of the improvement of farmers’ digital literacy on opportunistic behavior in pest control. The results are as follows. Firstly, the improvement of farmers’ digital literacy can restrain their opportunistic behavior in pest control. Secondly, the improvement of farmers’ digital literacy restrain their opportunistic behavior through three paths, namely, enhancing the awareness of obeying pest control regulations for certified vegetables, reducing the cost and risk of pest control in obeying the certification standards. Thirdly, the traceable certification label plays a positive moderating role in the process of improving digital literacy to restrain farmers’ opportunistic behavior. Accordingly, this study suggests strengthening the training of farmers’ digital literacy, promoting the digitalized traceability system for certified vegetables, establishing examination mechanisms for online pesticide purchases and logistics distribution, and imposing severe penalties for opportunistic behaviors. Full article

Electricity theft remains a persistent challenge, particularly in developing economies where infrastructure limitations and socioeconomic disparities contribute to illegal connections. This study analyzes the determinants influencing electricity theft in Kinshasa, the Democratic Republic of Congo, using a logistic regression model applied to 385 observations, which includes random bootstrapping sampling for enhanced stability and power analysis validation to confirm the adequacy of the sample size. The model achieved an AUC of 0.86, demonstrating strong discriminatory power, while the Hosmer–Lemeshow test (p = 0.471) confirmed its robust fit. Our findings indicate that electricity supply quality, financial stress, tampering awareness, and billing transparency are key predictors of theft likelihood. Households experiencing unreliable service and economic hardship showed higher theft probability, while those receiving regular invoices and alternative legal energy solutions exhibited lower risk. Lasso regression was implemented to refine predictor selection, ensuring model efficiency. Based on these insights, a multifaceted policy approach—including grid modernization, prepaid billing systems, awareness campaigns, and regulatory enforcement—is recommended to mitigate electricity theft and promote sustainable energy access in urban environments. Full article

Background: Chinese school-age students are at a high risk of developing obesity. However, few studies have reported individualized ways to prevent obesity by age, gender, and living regions. Methods: A total of 11,285 students aged 6–18 years were recruited and participated in this cross-sectional study. Questionnaires were used to assess scores of dietary diversity (DDS), physical activity (PA) duration, and nutritional literacy awareness. According to age and gender-specific BMI thresholds, the participants were categorized into normal and participants with obesity groups. Pearson correlation and logistic regression analysis were used to explore the association between nutritional literacy, DDS, PA, and the risk of BMI or obesity. Results: Scores of nutritional literacy were positively associated with Total DDS, Plant DDS, Animal DDS, and PA, and were negatively associated with BMI. High Total DDS (OR = 0.878, p = 0.030), Plant DDS (OR = 0.885, p = 0.027), and PA (OR = 0.869, p = 0.022) were strongly associated with a low risk of obesity. Furthermore, high Total DDS and Plant DDS decreased the risk of obesity only in the high PA group but not in the low PA group. High PA only decreased the risk of obesity in the high Total DDS and high Plant DDS group. Gender-, age-, and living-region-specific associations were also observed. Conclusions: Diverse dietary intakes and physical activity are essential for reducing the risk of obesity in Chinese school-age students. Notably, gender-, age-, and living-region-specific health and nutritional literacy education are required in school-age children to prevent obesity. Full article

This study aims to explore the associations between menstrual health, lifestyle behaviors, biological traits, and coping strategies among female students at a Vietnamese medical university. A cross-sectional survey was conducted among 884 female students across five academic majors. Data on demographics, menstrual patterns, biological characteristics, lifestyle behaviors, and coping mechanisms were collected. Statistical analyses included descriptive statistics, correlation, and logistic regression to identify significant predictors of self-reported menstrual changes post university admission. Of the 884 participants, 49.8% reported menstrual changes after entering university. Among the lifestyle-related factors, increased daily electronic use (mean = 5.83 h) and later bedtimes (mean = 23:58) were associated with menstrual change (p < 0.01). Older age and higher academic year emerged as significant predictors of menstrual changes (p < 0.001). Additionally, students with blood groups A and B exhibited a higher risk compared to those with group O (p < 0.05), and Rh-positive status was also significantly associated with menstrual changes (p = 0.05). In terms of knowledge and coping practices, students who had premenstrual syndrome awareness since school were significantly less likely to report menstrual changes (p = 0.003). Although use of pain relief, particularly painkillers, correlated with higher reported pain severity, it was not directly linked to menstrual change. On the other hand, clinic consultations were positively associated with menstrual changes (p = 0.003), while students who relied on their mothers as counselors exhibited a protective association (p = 0.001). Menstrual health in university-aged women is influenced by a complex interplay of lifestyle behaviors, biological traits, and menstrual knowledge. Early education and structured coping support may serve as protective factors. The findings call for targeted menstrual health programs in university settings. Full article

Background: Sexual assault victims involving penetration are at risk of contracting human immunodeficiency virus (HIV). Post-exposure prophylaxis (PEP) can effectively prevent HIV infection if initiated promptly within 72 h following exposure and adhered to for 28 days. Nonetheless, therapeutic adherence amongst sexual assault victims is low. Victim-centered care, provided by specially trained forensic nurses and midwives, may increase adherence. Methods: We conducted a retrospective case–control study to evaluate the impact of sexual assault center (SAC)—centered care on adherence to PEP compared to care received in the emergency department (ED). Data from January 2011 to February 2022 were reviewed. Multivariable logistic regression analysis was employed to determine the association between centralized specific care for sexual assault victims and completion of the 28-day PEP regimen. The secondary outcome assessed was provision of psychological support within 5 days following the assault. Results: We analyzed 856 patients of whom 403 (47.1%) received care at a specialized center for sexual assault victims. Attendance at the SAC, relative to the ED, was not associated with greater probability of PEP completion both in the unadjusted (52% vs. 50.6%; odds ratio [OR]: 1.06, 95% CI: 0.81 to 1.39; p = 0.666) and adjusted (OR: 0.81, 95%CI 0.58–1.11; p = 0.193) analysis. The care provided at the SAC was associated with improved early (42.7% vs. 21.5%; p < 0.001) and delayed (67.3% vs. 33.7%; p < 0.001) psychological support. Conclusions: SAC-centered care is not associated with an increase in PEP completion rates in sexual assault victims beyond the increase associated with improved access to early and delayed psychological support. Other measures to improve PEP completion rates should be developed. What is already known on this topic—Completion rates for HIV post-exposure prophylaxis (PEP) among victims of sexual assault are low. Specialized sexual assault centers, which provide comprehensive care and are distinct from emergency departments, have been suggested as a potential means of improving treatment adherence and completion rates. However, their actual impact on treatment completion remains unclear. What this study adds—This study found that HIV PEP completion rates in sexual assault victims were not significantly improved by centralized care in a specialized sexual assault center when compared to care initiated in the emergency department and continued within a sexually transmitted infection clinic. However, linkage to urgent psychological and psychiatric care was better in the specialized sexual assault center. How this study might affect research, practice or policy—Healthcare providers in sexual assault centers should be more aware of their critical role in promoting PEP adherence and improving completion rates. Policymakers should ensure that measures aimed at improving HIV PEP outcomes are implemented at all points of patient contact in these centers. Further research is needed to assess the cost-effectiveness of specialized sexual assault centers. Full article

Anthelmintic resistance in livestock is a growing concern worldwide, with significant implications for animal health and agricultural productivity. This study explores the perceptions of veterinarians and farmers in Bosnia and Herzegovina regarding the factors contributing to anthelmintic resistance in Haemonchus contortus nematodes. Data were collected through structured questionnaires completed by 106 veterinarians and 188 farmers in 2022 and 2023. The analysis focused on self-reported therapeutic practices, farm management and environmental variables. Logistic regression, including Firth’s penalized approach, was used to assess associations between these perceived factors and the reported occurrence of resistance. Notably, combination anthelmintic treatments were perceived as a significant risk factor (OR > 49.3), while higher altitude was seen as potentially protective (OR = 0.10). Routine prophylactic deworming was associated with an increased likelihood of perceived resistance (OR = 173.7), whereas staying informed about newly registered products was perceived as protective (OR = 0.34). Although the findings are based on the self-reported perceptions and practices of veterinarians and farmers, they align with globally recognized trends and offer the first structured insights into factors perceived to contribute to anthelmintic resistance in Bosnia and Herzegovina. This study underscores the importance of awareness and responsible anthelmintic use and the need for improved diagnostics and ongoing education to combat anthelmintic resistance. Full article