Search Results (210)

Background: Medical students often face substantial psychological stress, which can increase the risk of substance use, professional detriment, and insufficient patient care. However, substance use in medical students remains understudied in Iraq. This study highlights the prevalence, patterns, risk factors, and negative effects of substance use among medical students at the University of Baghdad. A cross-sectional study involving 414 medical students at the University of Baghdad was conducted. The questionnaire included sociodemographic variables and the Alcohol, Smoking, and Substance Involvement Screening Test to screen for psychoactive substance use. The lifetime prevalence of substance use was 38.9%. Among substance users, 42.8% used nicotine, 22.3% used sedatives, 4.3% used inhalants, and 3.1% used amphetamines, with only 27.3% reporting polysubstance use. Through multivariate logistic regression, it was identified that males are approximately 2.8 times more likely to use substances compared to females (OR: 2.8, 95% CI: 2.1–5.2, p-value < 0.001), and students with a positive family history of substance use are approximately 3.1 times more likely to use substances compared to those without (OR: 3.1, 95% CI: 2.8–7.5, p-value < 0.001). These findings underscore the importance of implementing early preventive strategies, targeted mental health interventions, and substance use awareness programs within Iraqi medical institutions. Full article

Background: Despite a decline observed in smoking rates amongst adults in many high-income countries, tobacco usage among adolescents remains a significant concern, particularly in Central and Eastern Europe, Romania being no exception. This cross-sectional study aims to assess the prevalence of smoking among teenagers enrolled in several public schools in Bucharest and the surrounding county, Ilfov, while also exploring their attitudes, perceptions, and experiences regarding tobacco. Methods: A public health campaign, conducted in collaboration with multiple institutions between September 2023 and March 2024, sought to provide secondary school students with updated information on smoking and its implications through presentations at schools. Following these presentations, students voluntarily completed anonymous on-paper questionnaires consisting of 10 multiple-choice questions designed to gauge their knowledge and attitudes towards smoking, conceptually inspired by internationally validated instruments such as the Global Youth Tobacco Survey. Results: A total of 945 teenagers participated in our study, with a median age of 13.04 years (standard deviation of ±1.08). Results indicate that 22.85% (n = 216) of teenagers had attempted smoking at the time of the investigation. Additionally, 57.88% (n = 547) of respondents reported exposure to second-hand smoke at home, and 40.42% (n = 382) had been invited to smoke previously. Conclusions: Various factors influence smoking behaviors among teenagers, with peer pressure and familial background playing significant roles in shaping their attitudes toward smoking. Our study highlights the vulnerability of the young Romanian population to these influences, emphasizing the need for initiatives aimed at mitigating tobacco use and fostering a healthier future environment. Nonetheless, these findings shall serve as an instrument for the development of school-based prevention programs and stricter tobacco usage policies. Full article

Background: Smoking remains a major global public health challenge. As smoking often begins in early adolescence, early preventive programs are essential, yet research focusing exclusively on elementary school students is limited. This study measured smoking prevalence, smoking-related knowledge and attitudes, and the impact of a school-based intervention on these outcomes among 12–13-year-old students in Larissa, Greece. Methods: A total of 769 students participated (response rate: 75%). Knowledge, attitudes, and smoking prevalence were assessed at baseline. The intervention group (n = 316) was exposed to audiovisual and printed materials, and both groups were followed up at three- and twelve months post-intervention. Multivariable linear mixed-effects models and generalized estimating equations were used to evaluate intervention effects. Results: Baseline characteristics were balanced between groups. A statistically significant stage × group interaction was observed, indicating improvements in smoking-related knowledge and attitudes (p < 0.001) and a reduced likelihood of smoking initiation (p = 0.011) in the intervention group. Conclusions: This school-based intervention demonstrated significant improvements in knowledge and attitudes toward smoking and reduced the likelihood of smoking initiation. These findings support integrating early prevention programs into school curricula as a potentially effective approach to improving smoking-related outcomes. Full article

Background/Objectives: Cervical cancer remains a major cause of morbidity and mortality among women worldwide, marked by stark geographic and socioeconomic disparities. Preventable via HPV vaccination and screening, progress toward elimination varies widely across and within countries. This narrative review synthesizes the epidemiology, including incidence, mortality, survival, and stage distribution, as well as risk factors and the coverage/equity of HPV screening and vaccination programs. Methods: Comprehensive searches were performed in PubMed, Web of Science, Scopus, and Google Scholar (no date restrictions; English only). Included were original epidemiological studies, systematic reviews, meta-analyses, and international reports on burden, risk factors, or prevention indicators. Data were qualitatively synthesized into three themes: epidemiological patterns, risk factors, and screening/prevention programs. Results: Persistent high-risk HPV infection causes nearly all cervical cancers, predominantly HPV16/18, with regional variation in other types. Strong co-factors include HIV immunosuppression, early sexual debut, multiple partners, high parity, long-term oral contraceptive use, and smoking. Inequalities in incidence, late diagnosis, and survival are driven by socioeconomic disadvantages, low education, rural residence, and poor health system access. Screening ranges from cytology/VIA to primary HPV testing, but coverage is low and inequitable in high-burden settings. HPV vaccination has expanded yet faces major gaps in low- and middle-income countries. Conclusions: Cervical cancer burden concentrates in low-resource and marginalized populations. Global elimination demands accelerated, equitable scale-up of HPV vaccination and screening, alongside health system strengthening and barrier reduction. Full article

Background: Nicotine use among the youth has been on the rise, especially with the introduction of E-cigarettes. This has sparked concerns regarding E-cigarettes and traditional cigarettes in terms of patterns, dependence, and perceptions within the youth population, which are issues this study aimed to investigate. Methods: A cross-sectional survey was conducted among university students at Ajman University, which is in the Middle East and North Africa (MENA) region. Using the Cigarette Dependence Scale (CDS-12) and Penn State Electronic Cigarette Dependence Index (PS-ECDI), dependence on both cigarettes and E-cigarettes was quantified. Results: Out of 1713 respondents, 18.9% were currently using nicotine products, including E-cigarettes (12.7%) and traditional cigarettes (5.1%). Nicotine use was significantly associated more with males than females with an odds ratio of 4.14. However, there was no difference between genders in the dependence scores. In addition, dual nicotine use and an earlier onset of nicotine consumption were associated with significantly higher dependence scores than single users and a late onset of smoking. Participants overall attributed cigarettes and E-cigarettes as equally harmful. Conclusions: Both cigarette and e-cigarette use were prevalent and associated with notable dependence. Although E-cigarettes are often promoted as cessation aids, their use in our sample did not appear to facilitate quitting and may instead sustain nicotine dependence. Targeted youth-focused cessation programs and stricter marketing and sales regulations are essential to prevent further normalization. Longitudinal studies are needed to track evolving patterns and health impacts in the MENA region. Full article

One of the challenges post-COVID-19 is reducing the negative impacts on quality of life, performance, and independence in activities of daily living. Assessing functional dependence in adults one year after acute infection can help to understand the long-term consequences, evaluate the impact on quality of life, plan rehabilitation and healthcare, identify the most vulnerable groups, measure the socioeconomic impact, and support public policies and clinical decisions. Objectives: The objectives of this study are as follows: (a) to assess the prevalence of functional dependence in Brazilian adults with COVID-19; (b) to analyze the association between the study variables; and (c) to determine the factors associated with functional dependence. Methods: This was an observational, cross-sectional study with 987 adults (18 to 59 years old) living in the State of Paraná (Brazil) hospitalized for COVID-19 between March and December 2020. Data were collected by telephone 12 months after the acute infection using an instrument to retrieve sociodemographic and health information, and a functional dependence scale to assess dependence before COVID-19 retrospectively (using participant recall information) and at the time of the interview. Data were analyzed using penalized logistic regression after imputing missing data. Data were analyzed using penalized logistic regression after imputing missing data. Results: Functional dependence after COVID-19 was 5.0% and was associated with low levels of education, not having a partner, living with someone, not owning a home, experiencing job changes, requiring care, obesity, smoking, multimorbidity, ICU admission in the acute phase, use of invasive ventilation, or having Long COVID. Individuals who required care or used invasive ventilation support were, respectively, 9.3 and 6.5 times more likely to develop dependence after COVID-19. Despite adjustment for multiple factors, the magnitude of the observed effects warrants cautious interpretation, as unmeasured or residual confounding effects may still be present. Sample recall bias due to collection after 12 months and the presence of the alpha variant without COVID-19 vaccination coverage may limit data generalization. Conclusions: The results highlight the need to emphasize the public health implications of identifying functional dependence. In this vein, it is necessary to implement preventive measures, identify and monitor more vulnerable groups, plan rehabilitation programs, and develop public health policies. Full article

Background/Objectives: Cardiovascular diseases (CVDs) remain a leading cause of mortality worldwide, with a particularly high burden in Central Asian countries. Despite ongoing urbanization, rural populations constitute a significant demographic in this region, yet epidemiological data stratified by urban and rural residence are limited and fragmented. This systematic review aimed to synthesize current evidence on the incidence, prevalence, mortality, and risk factor profiles of CVDs among urban and rural populations in Central Asia, identify disparities, and inform targeted prevention and control strategies. Methods: A systematic literature search was conducted across the PubMed, Science Direct, Web of Science, and Google Scholar databases for studies published between 2015 and 2025. Included studies reported cardiovascular health indicators with urban–rural stratification in Kazakhstan, Kyrgyzstan, Uzbekistan, Tajikistan, and Turkmenistan. Data extraction and qualitative synthesis were performed, with methodological quality assessed using the Newcastle–Ottawa Scale. Results: Eight original studies met the inclusion criteria, encompassing national and regional datasets with diverse designs, including retrospective analyses, cross-sectional surveys, and registry data. Overall, CVD incidence and prevalence showed increasing trends in both urban and rural areas, with consistently higher mortality rates in urban populations. Key modifiable risk factors—hypertension, obesity, dyslipidemia, and smoking—were prevalent, particularly in rural settings. Variability in healthcare access and preventive program implementation contributed to the observed disparities. Limited data from some countries, particularly Tajikistan and Turkmenistan, highlight gaps in epidemiological surveillance. Conclusions: The cardiovascular disease burden in Central Asia demonstrates significant urban–rural disparities, underscoring the need for tailored public health interventions and enhanced healthcare resource allocation in rural regions. Strengthening epidemiological monitoring and implementing region-specific prevention programs targeting modifiable risk factors are imperative for reducing CVD morbidity and mortality. Further high-quality research is necessary to address existing data gaps and optimize cardiovascular health strategies across the region. Full article

Background/Objectives: Blood donation is essential to health systems and represents a valuable epidemiological model for studying physiological adaptation to controlled blood loss. Regular blood donors constitute a distinct, health-screened population whose biological responses offer unique insight into mechanisms of resilience and key determinants of population health. Hypoxia-inducible factor 1-alpha (HIF-1α) is a key regulator of erythropoiesis and cellular response to hypoxia, and its modulation following blood donation may inform donor safety and the sustainability of blood donation programs. This study aimed to characterize the sociodemographic, lifestyle, and anthropometric profiles of blood donors in relation to hematopoietic biomarkers (vitamin B12 and folic acid) and to evaluate changes in serum HIF-1α concentration after donation, emphasizing the public health relevance of voluntary blood donation. Methods: A cross-sectional study was conducted among 324 voluntary blood donors (159 regular and 165 occasional). Serum HIF-1α was measured before and 30 min after donation, together with vitamin B12 and folic acid levels. Sociodemographic and lifestyle characteristics (physical activity, smoking, dietary habits) were collected through standardized questionnaires (EHIS-3, FFQ), and anthropometric parameters were assessed. Results: Regular donors were older and predominantly male, with comparable socioeconomic indicators between groups. Both regular and occasional donors showed favorable lifestyle profiles, including low smoking prevalence and moderate physical activity. Skinfold thickness was significantly greater in regular donors (p < 0.001). The main biological finding was a robust post-donation increase in HIF-1α concentrations (≈80%, p < 0.001), independent of donation frequency or lifestyle. No significant associations were found between lifestyle factors and vitamin B12 or folate levels. Conclusions: Blood donation induces a rapid elevation in HIF-1α, reflecting activation of hypoxia-responsive pathways and short-term hematopoietic adaptation. Beyond its biomedical relevance, voluntary blood donation represents a meaningful epidemiological and public health model for studying physiological resilience and the health benefits of altruistic behavior. These findings underscore the importance of donor surveillance and motivation as components of broader preventive health and health equity strategies. Full article

Adolescence is a critical life period connected with the initiation of substance use. Exploring the prevalence of and contributors to adolescents’ smoking, drinking, and drug use is essential for developing effective health education programs. This study aims to detect prevalence rates of adolescent substance use and their association with sociodemographics and a set of psychological, social, and school-related variables. Participants were high school students (9th graders, N = 1590; 694 males, 896 females) in Békés county, Hungary. The lifetime prevalence rates were the following: smoking (47.2%), alternative smoking (49.2%), drinking (85.7%), cannabis use (7.6%), sedative use (7.0%), and designer drug (herbal) use (3.7%), with gender differences (a surplus of girls) found only in smoking and sedative use. Using bivariate logistic regression analyses, depressive and psychosomatic symptoms and internet addiction increased the odds of all types of substance use, life satisfaction, future orientation, and social support from the family, while school achievement and school satisfaction showed odds-reducing effects. In multivariate analyses, the various types of substance use were predicted by different variables, while psychosomatic symptoms, social support from the family, and school achievement seemed to be the most relevant contributors. Health education programs should also incorporate fostering mental health to prevent adolescent substance use. Full article

Background/Objectives: Micronutrient deficiencies during infancy remain a major public health concern, particularly in developing countries. Although exclusive breastfeeding is the optimal source of nutrition for infants up to six months of age, limited studies have simultaneously evaluated multiple micronutrient statuses in this population. This study aimed to assess the levels of vitamin D, iron, and other micronutrients—including vitamins A, E, B12, folic acid, zinc, and copper—in exclusively breastfed infants. Methods: This cross-sectional study was conducted between 2022 and 2024 at a university well-child clinic in İzmir, Turkey. A total of 132 healthy, exclusively breastfed six-month-old infants were included. Blood samples were analyzed for hemogram, serum iron, ferritin, 25(OH)D, vitamins A, E, B12, folic acid, zinc, and copper. Sociodemographic data and supplementation practices were recorded. Deficiency cut-offs were defined according to WHO and national guidelines. Results: Among the infants, 40.2% had iron deficiency or anemia, and 14.4% had vitamin D deficiency. Vitamin B12, A, E, zinc, and copper deficiencies were identified in 29.5%, 2.4%, 4%, 7.4%, and 6.6% of infants, respectively. Regular vitamin D and iron supplementation were significantly associated with lower deficiency rates (p < 0.05). Maternal education level, dressing style, and smoking status were significantly related to infant vitamin D status. Conclusions: Despite national supplementation programs, iron and vitamin D deficiencies remain common in exclusively breastfed infants. Routine and regular supplementation should be emphasized, and subclinical deficiencies—particularly vitamin B12—should be considered. Broader studies evaluating maternal nutritional factors and socioeconomic determinants are warranted to guide preventive strategies. Full article

Background/Objectives: Thirdhand smoke (THS), residual tobacco pollutants persisting on surfaces, dust, and fabrics, poses specific risks to infants and children, yet its implications for nursing remain underexplored. This scoping review mapped existing evidence on THS in neonatal and pediatric contexts and synthesized nursing implications, focusing on nurses’ knowledge, unintentional environmental contamination, and educational roles. Methods: Following JBI methodology and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a three-step search was performed across MEDLINE, CINAHL, Scopus, Web of Science, Cochrane Library, Google Scholar, and OpenGrey. Studies were included if they addressed (1) nurses’ knowledge, beliefs, and attitudes toward THS-related risks in infants and children; (2) nurses’ contribution to unintentional environmental THS contamination; or (3) nurse-led educational or preventive interventions targeting parents or communities. Results: Among 563 records, 8 met inclusion criteria. Four investigated nurses’ awareness and perceptions, revealing limited understanding of THS despite recognition of its harmfulness. One study examined contamination, detecting nicotine residues on nurses’ fingers, suggesting possible in-hospital transmission. No nurse-led interventions specifically targeting THS were found, though broader smoke-exposure education programs showed benefits when supported by nursing staff. Conclusions: Evidence is scarce but underscores significant gaps in nurses’ knowledge, clinical guidance, and educational initiatives concerning THS. Strengthening nursing education and research is essential to mitigate THS exposure in neonatal and pediatric settings and enhance nurses’ preventive and advocacy roles. Full article

Objectives: This study aims to evaluate teachers’ lifestyle habits and to investigate their knowledge and behaviors related to cancer screening. Methods: This cross-sectional survey was performed among teachers randomly selected from schools located in the Campania region, Italy. Results: Only 17% of the teachers were current smokers, while 72.1% consumed alcohol. Female teachers, those who were married/cohabitant, and those who discussed with students about alcohol consumption were more likely to have never smoked or drunk alcohol. Female and older teachers, those with a university or a master/PhD degree, and those who had a moderate/high level of physical activity (PA) were more likely to sufficiently consume fruits and vegetables. Only 20.9% of teachers had a moderate/high level of PA. Those who had at least one child, who taught humanistic and support disciplines, and who needed additional information on healthy lifestyle habits were less likely to have a moderate/high level of PA. Among participants, 42.3% had ever undergone mammography for screening and 37.5% a Pap test and a fecal occult blood test. Conclusions: This survey describes a worrying prevalence of unhealthy behaviors and low adherence to screening programs among Italian teachers, suggesting the need for education and screening campaigns to improve preventive strategies in this population. Full article

Background/Objectives: While smoking, areca nut chewing, and alcohol are established risk factors, Hepatitis C virus (HCV) infection has emerged as a potential risk for oral neoplasia. This study explores any association of HCV infection with oral potentially malignant disorder (OPMD) and oral cancer, following adjustment for HCV-related liver disease in a large screening cohort. Methods: Data from 37,720 participants in the Changhua Community-Based Integrated Screening Program (2005–2014) with smoking or areca nut use history were analyzed. OPMD and cirrhosis were identified at screening, while oral and liver cancers were diagnosed during follow-up. Information on demographics, lifestyle, and clinical factors, including chronic and active HCV infection, was collected. Multinomial logistic regression was used to assess associations between HCV status and disease outcomes. Results: The prevalence of hepatitis C viremia was higher in the OPMD group (4.4%) and oral cancer group (3.3%) compared to the screen-negative group (2.7%), and highest in the cirrhosis/liver cancer group (23.3%). The odds ratios of OPMD and oral cancer were 1.59 (95% CI: 1.20–2.01) and 1.22 (95% CI: 0.67–2.23), respectively, in subjects with hepatitis C viremia compared to those without. After adjusting for confounding factors, individuals with hepatitis C viremia were at increased risk of OPMD by 50% (aOR = 1.50; 95% CI: 1.17–1.92) but not a statistically significant elevated risk for oral cancer (aOR = 1.09; 95% CI: 0.59–2.01), which was possibly attenuated due to HCV-related liver disease (aOR = 11.59; 95% CI: 8.33–16.13). Conclusions: HCV infection may act as an early risk factor for OPMD, though its progression to oral cancer may occur alongside the risk of HCV-related liver diseases. Including HCV status in screening may aid early detection and secondary prevention of oral cancer in high-risk groups. Full article

Background: Obesity and insomnia are prevalent public health issues with shared behavioral and physiological pathways. However, their interplay remains understudied in occupational cohorts. Obesity and insomnia are prevalent public health issues with shared behavioral and physiological pathways. However, their interplay remains understudied in occupational cohorts. This study aimed to evaluate the associations of sociodemographic factors, lifestyle habits, and insomnia severity with multiple obesity indices in a large population of Spanish workers. Methods: We conducted a cross-sectional analysis of 84,898 workers (2021–2024). Data were obtained from annual occupational health assessments conducted across multiple Spanish regions between 2020 and 2024. Insomnia severity was assessed using the Insomnia Severity Index (ISI), dietary quality using the 14-item Mediterranean Diet Adherence Screener (MEDAS-14), and physical activity using the International Physical Activity Questionnaire—Short Form (IPAQ-SF). Adiposity was measured using Body Mass Index (BMI), waist-to-height ratio (WtHR), the Clínica Universidad de Navarra–Body Adiposity Estimator (CUN-BAE), and the Metabolic Score for Visceral Fat (METS-VF). Multivariable logistic regression models were used to examine associations adjusted for age, sex, education, and occupational social class. Results: Higher ISI scores were significantly and independently associated with elevated adiposity across all indices, with the strongest association observed for METS-VF (odds ratio = 1.19, 95% CI 1.14–1.25, p < 0.001). Women showed higher mean CUN-BAE and METS-VF values than men (CUN-BAE: 37.4 ± 6.2 vs. 25.6 ± 6.4; p < 0.001; METS-VF: 5.7 ± 0.7 vs. 6.4 ± 0.6; p < 0.001), despite lower BMI (25.3 ± 4.8 vs. 26.8 ± 4.3; p < 0.001). Lower physical activity (OR = 5.70; 95% CI 4.91–6.50), poor adherence to the Mediterranean diet (OR = 3.29; 95% CI 2.88–3.70), smoking (OR = 1.29; 95% CI 1.22–1.36), and lower occupational class (Class III: OR = 1.77; 95% CI 1.56–1.97) were also significantly associated with higher obesity markers. Associations were more pronounced among women and participants with severe insomnia symptoms. Conclusions: Insomnia severity, sociodemographic disadvantage, and unhealthy behaviors (low physical activity, poor diet, smoking) were all independent correlates of general and visceral adiposity. The findings underscore the need for comprehensive workplace health programs that integrate sleep quality assessment, dietary improvement, and physical activity promotion to prevent obesity and its metabolic consequences. Full article

Background/Objectives: Smoking is an established cofactor for cervical carcinogenesis, but evidence on how Smoking Pattern Changes around cohort entry relate to risk in Japan is limited. We quantified cervical cancer risk by baseline smoking status and by changes between two routine health checkups in a nationwide cohort. Methods: We used the Japan Medical Data Center claims–checkup database between January 2005 and July 2022. Women with ≥2 pre-index checkups were included; the index date was the second checkup. Self-reported smoking at each visit defined never, former (quit), new (initiated), and current (persistent) smokers; checkup pairs >36 months apart were excluded. Incident cervical cancer required ICD-10 C53 plus cancer-directed treatment (surgery, radiotherapy, or systemic antineoplastic therapy). Multivariable Cox models estimated hazard ratios (HRs) with 95% CIs, adjusting for age, BMI, alcohol, exercise, hypertension, diabetes, cerebrovascular and cardiovascular disease, and cholangitis. Results: Among 1,330,797 women, incidence rates (per 100,000 person-years) were 151.4 in never smokers and 244.9 in ever smokers. Ever versus never smoking was associated with higher risk (HR 1.53, 95% CI 1.43–1.62). A graded risk was observed across Smoking Pattern Change categories versus never: former HR 1.44 (1.15–1.79), new HR 1.51 (1.20–1.90), current HR 1.54 (1.44–1.64). By age, HRs were 1.58 (1.47–1.70) for <50 years and 1.35 (1.17–1.55) for 50–64 years; ≥65 years was not statistically significant (HR 0.69, 0.30–1.59). Conclusions: Smoking was associated with substantially higher cervical cancer risk, with a clear risk gradient from former to new to current smoking. The rapid elevation in new smokers and residual risk after quitting support integrating proactive cessation and initiation prevention into risk-stratified screening and routine health-check programs in Japan. Full article