Search Results (2,389)

Background: Dengue infection is an expanding public health threat in Indonesia, increasingly reported in semi-urban areas undergoing rapid demographic and environmental change, where household-level determinants remain poorly characterised. Methods: We conducted a case–control study in the Deli Serdang district, North Sumatra, evaluating sociodemographic and environmental risk factors for dengue. Patients admitted to the district referral hospital (July–September 2024) were screened via medical records. Laboratory-confirmed dengue cases were compared with non-dengue febrile controls. Housing conditions and sociodemographic characteristics were assessed using a validated electronic questionnaire with photographic documentation. Multivariable logistic regression identified independent risk factors. Results: Of 238 individuals screened, 39 dengue cases and 78 controls were enrolled. Male sex (aOR 6.7, 95% CI 1.3–33.7), student status (aOR 7.8, 95% CI 1.1–56.5), absence of window screens (aOR 12.9, 95% CI 3.1–53.8), and surrounding vegetation (aOR 7.3, 95% CI 1.7–31.9) were independently associated with dengue infection. Rural residence was overrepresented among cases, suggesting expansion beyond traditional urban boundaries. Conclusions: Dengue risk in a transitional setting is shaped by demographic exposure and modifiable structural vulnerabilities. Integrated prevention strategies, including window screening, covered water storage, environmental management, and school-based vector control, are needed in rapidly urbanising districts. Full article

Background: Open defecation (OD) has remained a threat to the attainment of SDG 6 (sanitation and hygiene). This study measured the level of exposure to the “Clean Nigeria, Use the Toilet” campaign against open defecation, determined the level of public knowledge about open defecation-related harms and diseases, ascertained the public attitude towards open defecation, and established the prevailing defecation practices and the perceived barriers to toilet usage in Ebonyi state, the most prevalent OD state in Nigeria. Methods: The study employed a survey design, using a structured questionnaire for data collection. The multi-stage sampling technique was employed in selecting the respondents from two randomly selected Local Government Areas (LGAs) in the state. Analysis was conducted using 384 valid responses. Results: The results were presented in simple percentage frequency tables and interpreted through the descriptive method, while the Chi-Square test was used to analyse the formulated hypotheses, using the decision rule of p < 0.05. The findings show a high level of awareness of the campaign against open defecation, through the radio and community engagements by environmental activists/NGOs, even though regular access to such information was limited. The results also showed inadequate knowledge of the public health implications of open defecation, whereas good knowledge of environmental consequences was reported. The study found favourable attitudes toward OD practice and persistent open defecation, and major barriers to toilet usage include the high cost of toilet construction, lack of access to toilet facilities, poor sanitation and management of available toilets, and perceived risks of contracting infection from public toilets. However, the Chi-Square values showed that the SBCC campaign was significantly associated with knowledge, attitude, and practice (p < 0.05). Conclusions: The study concluded that localised, culturally relevant and socio-demographically targeted communication interventions, grassroot advocacy, community watch, and neighbourhood taskforce on open defecation, in addition to the provision of aids for the construction of modern toilets with water facilities, are required to combat open defecation in Ebonyi and related contexts in Nigeria. Full article

Background and Objectives: Cervicogenic headaches (CGH) are increasingly common among college students and may negatively affect academic performance and sleep quality. This study aimed to identify the self-reported prevalence of cervicogenic-type head and neck pain in a convenience sample of Saudi college students and to examine its associations with electronic device use, physical activity, and sleep quality among college students in Saudi Arabia. Materials and Methods: A cross-sectional study was conducted among 313 college students from various Saudi university colleges using an online self-administered questionnaire. The questionnaire gathered information on sociodemographic characteristics, electronic device usage, neck pain awareness, physical activity levels, and sleep quality. Descriptive statistics were used to summarize the data, and chi-square tests were used to explore associations between potential predictors and the prevalence of self-reported cervicogenic-type head and neck pain consistent with possible CGH. Results: Most participants were female (84.3%) and aged 18–25 years (95.2%). Cervicogenic-type head and neck pain were reported by 65.2% (n = 204/313), while 56.5% experienced moderate to severe stress. A significant association was found with perceived stress (p = 0.002). Prolonged electronic device use (>4 h/day: 77.9%; p < 0.01), lower physical activity (p = 0.056), medication use (p < 0.01), headache exacerbation with inactivity (p = 0.006), and poor sleep quality (95.1% with PSQI > 10; p = 0.044) were significantly associated. Conclusions: These findings highlight associations between excessive electronic device use, low physical activity, and poor sleep quality with self-reported cervicogenic-type head and neck pain among Saudi college students. Future longitudinal studies and randomized controlled trials are needed to determine whether targeting these factors reduces the prevalence of CGH. Full article

Introduction: Patients are increasingly aware of ways to manage their own health—especially regarding chronic diseases—along with the fundamental factors that should be present in well-organized and patient-oriented healthcare organizations. Due to the fact that the image of healthcare organizations depends on patients’ opinions, healthcare organizations are continuously improving and transforming their processes to increase patient satisfaction. This study aimed to analyze the relationship between patients’ opinions about the public hospitals in which they were treated and selected factors, including socio-demographic characteristics, previous hospital experiences, sources of information, and satisfaction with hospitalization in Poland. Methods: A cross-sectional survey was conducted among patients hospitalized in eight public hospitals in Wrocław. A self-developed questionnaire included two sections: (I) opinions about the hospital (11 items) and (II) expectations and satisfaction (12 items). Questionnaires were distributed in person. Data were analyzed using descriptive and inferential statistics, including correlation and chi-square tests. Results: Hospital image was shaped mainly by interpersonal factors, particularly staff kindness (82.9%), access to specialists (75.4%), and a sense of safety (54.4%). Women were more likely than men to seek information about hospitals before admission (47.6% vs. 39.3%; p = 0.021). A positive correlation was found between patient expectations and satisfaction with hospitalization (ρ = 0.425; p < 0.001). Media exposure played a minor role in shaping hospital image (22.1%), while personal recommendations and previous experience were the dominant sources of influence. Conclusion: Patients’ assessments of hospital image are determined primarily by relational and communication factors rather than infrastructural or technical aspects. Sociodemographic characteristics, such as gender and previous contact with the institution, may moderate these perceptions. The findings highlight the need to strengthen patient-centered care models, improve communication competencies among health professionals, and develop transparent institutional communication strategies. Full article

Shopping mobility accounts for a significant share of total travel, while the growth of e-commerce is reshaping consumer purchasing behaviour and retail dynamics. Comprehending how territorial and sociodemographic factors shape the choice between physical and digital retail channels is therefore a key issue for transport planning and sustainable urban mobility. In this context, it is important to understand how accessibility to different classes of retailers is configured and how it can impact purchasing choices. Through a discrete choice analysis, this study examines the sociodemographic and territorial determinants of purchasing behaviour, focusing on the clothing market. Four purchase alternatives are considered: medium-sized and small urban retail stores, shopping malls, online purchasing, and no purchase. This multi-alternative framework enables the direct estimation of substitution patterns not only between physical and digital retail, but also between distinct forms of physical retail. Data were collected through a survey conducted in Southern Italy, providing empirical evidence from a territorial setting that is structurally underrepresented in the existing literature. A multinomial logit model and a two-level hierarchical logit model incorporating pedestrian accessibility—measured as walking time from residence to the nearest clothing store—alongside sociodemographic and territorial attributes were calibrated to analyse alternative choice behaviour. The calibrated models show interesting results, highlighting the role of pedestrian accessibility in the choice of clothing stores in city centres. Age, income, and territorial variables further differentiate channel preferences across population segments. The findings offer relevant implications for policymakers, governance managers, urban planners, and researchers concerned with retail location, sustainable accessibility, and consumer behaviour. These insights are highly valuable for developing planning that addresses the United Nations 2030 Agenda, particularly Sustainable Development Goal 11. Full article

Protecting bee populations is essential to ensuring the sustainability of pollination as a unique ecosystem service. In this study, the authors used a questionnaire survey to examine how and to what extent visitors to an agricultural event in Hungary value bee pollination, as well as which factors influence decision-making in this regard. The authors treated willingness to pay as a binary outcome and used logistic regression to identify its determinants. All explanatory variables were categorical, including sociodemographic factors and consumer attitude variables. Robustness checks were conducted using bootstrap estimation and an alternative probit specification, both of which confirmed the results. Based on the results, respondents’ average willingness to pay is 3.45 EUR/household/month, which amounts to 41.40 EUR/year. This amount indicates public support for financing the protection of ecosystem services provided by bees and can be considered an estimate of such support. Among the explanatory variables, gender, household size, and attitudes toward the consumption of bee products were statistically significantly related to willingness to pay. At the same time, income and respondents’ awareness were only marginally significant. The authors have proposed measures to strengthen environmental responsibility among both consumers and producers, which would represent long-term progress in the preservation of ecosystem services. Full article

Background: Spinal deformities in children represent a relevant public health issue, with possible long-term consequences. Timely identification of their determinants is essential for adequate prevention. Methods: This study was a secondary analysis of data from the 2019 Serbian National Health Survey, including 1309 children aged 5–14 years. Logistic regression with LASSO regularization and multiple ML algorithms were tested, with XGBoost selected as the optimal model. Class imbalance was addressed using class weighting and SMOTE. Model interpretability was achieved using SHAP analysis. Results: The prevalence of spinal deformities was 8.6%. Univariable analyses showed that age, poorer self-rated health, chronic illness, recent injuries, and pes planus were significantly associated with spinal deformities. Family-related variables showed no significant associations. Among the evaluated models, XGBoost demonstrated the most stable performance across the applied evaluation metrics and the best balance between predictive performance and interpretability. SHapley Additive exPlanations (SHAP) analysis showed that pes planus was the strongest determinant, followed by age and chronic illness, while socio-demographic and family factors had minimal influence. Conclusion: Explainable machine learning models, particularly XGBoost combined with SHAP, can allow for the identification and interpretation of key determinants of spinal deformities in children. Pes planus was shown to be modifiable and relevant associated determinant, supporting its importance in early screening and preventive strategies. Full article

Background/Objectives: Insomnia is a prevalent sleep disorder with substantial public health implications, yet epidemiological data from Serbia remain limited. This study aimed to assess the prevalence of clinically significant insomnia symptoms in the adult population of Serbia and to examine associated sociodemographic, comorbidity, psychosocial, and lifestyle factors. Materials and methods: A cross-sectional study was conducted from September 2023 to September 2025, including 2577 adults aged 18–89 years across Serbia. Insomnia symptom severity was measured using the Insomnia Severity Index (ISI), with scores ≥ 15 indicating clinically significant insomnia symptoms. Sociodemographic, comorbidity, psychosocial, and lifestyle factors were assessed via self-reported questionnaires. Multivariable logistic regression with LASSO variable selection was used to identify factors independently associated with clinically significant insomnia symptoms. Results: The prevalence of clinically significant insomnia symptoms (ISI ≥ 15) was 10.9%. Independent factors associated with clinically significant insomnia symptoms included being single (OR = 1.54) or divorced (OR = 1.75), lower educational attainment (OR = 0.71 per level increase), being retired (OR = 1.83) or a student (OR = 1.66), dermatological comorbidities (OR = 2.99), use of anxiolytic medications (OR = 2.44), exposure to stressful life events (OR = 1.88), engagement in late-night activities (OR = 1.37), consumption of coffee/tea (OR = 2.22), energy drink consumption (OR = 1.52), and late-night eating habits (OR = 1.27). Conclusions: Clinically significant insomnia symptoms among adults in Serbia are influenced by a complex interplay of sociodemographic, comorbidity, psychosocial, and lifestyle factors. These findings underscore the need for integrated approaches that address both medical and modifiable behavioral determinants in the prevention and management of insomnia symptoms. Full article

Background: Hepatitis B virus (HBV) infection poses a persistent global public health challenge, with substantial associated morbidity, mortality, and healthcare utilization. Although Saudi Arabia has maintained a national HBV vaccination program for decades, population-level data on hepatitis B infection knowledge, attitudes, and practices (KAP) remain scarce and regionally limited. This study aimed to comprehensively assess KAP toward hepatitis B infection prevention among the general adult population across all regions of Saudi Arabia and to identify independent sociodemographic predictors of each domain to inform targeted healthcare interventions. Methods: This nationwide cross-sectional study used a convenience sampling approach and a validated, self-administered questionnaire disseminated via online social media platforms across all regions of Saudi Arabia between August 2024 and February 2025. KAP was assessed using an instrument adapted from Haq et al. (Cronbach’s α = 0.70). Good knowledge was defined as a score ≥11/20 (≥55%), positive attitude as ≥5/7 (≥71.4%), and good practice as ≥6/8 (≥75%). Multivariable linear regression was used to identify independent predictors, adjusting for sociodemographic covariates. Results: A total of 1278 participants were included (mean age 30.3 ± 12.4 years; 60.9% female). Overall, 54.2% demonstrated good knowledge, 68.5% demonstrated positive attitudes, and only 16.2% exhibited good preventive practices. Screening (14.6%) and vaccination uptake (26.5%) were markedly low. Educational program participation was the strongest modifiable predictor across all three domains: knowledge (β = +1.89, 95% CI: 1.20–2.58, p < 0.001), attitude (β = +0.47, 95% CI: 0.25–0.69, p < 0.001), and practice (β = +1.43, 95% CI: 1.09–1.77, p < 0.001). Healthcare sector employment was independently associated with higher KAP scores across all domains. Income demonstrated a positive dose–response relationship with knowledge and practice outcomes. Polygyny was associated with lower scores across all three domains. Conclusions: Despite moderate knowledge and generally favorable attitudes, preventive practices remain critically deficient, revealing a persistent knowledge–practice gap. Integrated, behavior-oriented interventions targeting modifiable determinants, particularly health education, income disparities, and stigma, are urgently needed to support progress toward national and global HBV elimination targets. Full article

In the context of digital transformation, teachers’ information literacy has become a key factor for critical and effective teaching. This study seeks to determine its assessment and strengthening through a training intervention based on the Flipped Classroom model with a Massive Open Online Course (MOOC), supported by the DigComp Framework. To this end, a quasi-experimental pre-test–post-test design with a single group was used, complemented by comparative and correlational analyses according to sociodemographic variables. The study involved 810 primary school teachers from the Lambayeque region of Peru, considering sociodemographic variables such as age, gender, educational level, teaching experience, UGEL, and geographic area. It was found that teacher training based on the Flipped Classroom model with MOOC produced a statistically significant improvement in teachers’ information and digital literacy skills, evidenced by the increase in the post-test compared to the pre-test and confirmed by the Wilcoxon test (p < 0.05). It is concluded that training through Flipped Classroom with MOOC significantly strengthened teachers’ information skills; however, sociodemographic variables influence the levels and improvement achieved, which requires differentiated training strategies. Full article

This study investigates the determinants of farmers’ intention to convert to organic farming, focusing on the role of perceived territorial capital in rural Paraguay. Despite increasing demand for sustainable agricultural systems, the adoption of organic farming remains uneven, particularly in developing countries. Existing literature has mainly examined economic, socio-demographic, and psychological factors, while the role of territorial context has received less attention. The analysis relies on primary data collected through a structured survey of 167 conventional farmers across four Paraguayan departments. A logistic regression model is used to evaluate the effect of different dimensions of territorial capital—environmental, institutional, economic, and infrastructural—together with socio-economic and organisational characteristics, on farmers’ intention to convert within the next five years. The results indicate that perceived environmental capital significantly increases the probability of conversion intention (AME = 0.097, p < 0.05), while social capital, proxied by cooperative membership, raises it by 17.5 percentage points (p < 0.05). In contrast, perceived institutional capital shows a negative association (AME = −0.059, p < 0.10), and market orientation toward local markets reduces the probability of conversion (AME = −0.314, p < 0.05). Economic and infrastructural factors are not statistically significant. Overall, the study contributes by incorporating a territorial perspective into the analysis of adoption intentions and underlines the importance of strengthening environmental resources and social networks to support agro-ecological transitions. Full article

Background: The prior literature associates childhood sexual abuse (CSA), a profound early-life stressor, with long-term cardiometabolic and psychological effects. However, data on the distribution of CSA severity and patterns among different sociodemographic groups are limited. This study aimed to describe CSA prevalence, patterns, and severity among adults with hypertension and to examine its association with sociodemographic characteristics. Methods: This cross-sectional study evaluated a sample of 353 adults using various self-reported items. The analysis used individual responses and a binary variable indicating CSA exposure. A composite CSA severity score was determined by the number of reported abuse patterns and categorized into ordinal levels. Results: Of the participants, 42.2% reported exposure to CSA. The most frequently reported pattern was sexual contact or harassment (26.1%), followed by other sexual abuse acts (25.2%), forced sexual acts or exposure (18.7%), and coerced sexual activity (17.3%). Sexual assault or rape was reported by 20.7% of respondents. In terms of severity, 57.8% of respondents reported no CSA exposure, whereas 10.8% reported experiencing the highest severity. All examined sociodemographic factors were significantly associated with CSA exposure (p < 0.001). Conclusions: High CSA exposure and greater severity patterns were prevalent in this population, demonstrating notable sociodemographic gradients. These findings support the need for trauma-informed therapeutic awareness of CSA exposure among adults with hypertension. Nevertheless, the role of CSA as a risk factor for hypertension cannot be inferred from this study, as it only included subjects with preexisting hypertension. Longitudinal research is necessary to identify causal pathways. Full article

Urban forests and green spaces provide important ecosystem services that support climate adaptation, public health, and urban sustainability. Despite growing evidence from individual Portuguese cities, nationwide data on how citizens perceive, use, and support the governance of urban green spaces remain limited. This study addresses that gap through a nationwide online survey conducted in Portugal in 2024, gathering 927 valid responses from Portuguese adults across metropolitan, intermediate-density, and low-density municipalities, to investigate public perceptions of ecosystem services, patterns of green space use, management challenges, and attitudes toward urban forestry governance policies. Results revealed strongly positive perceptions of urban trees and green spaces across all sociodemographic groups, with over 95% of respondents acknowledging that urban green spaces positively influence physical and mental health. Regulating services, including air quality improvement, urban noise reduction, climate change mitigation, and flood mitigation, received the highest levels of agreement, while cultural ecosystem services were positively perceived but with comparatively lower agreement. Accessibility emerged as a critical determinant of visitation frequency: 85% of respondents could reach a green space within 15 min, and 82% of daily users lived within 300 m of one, broadly consistent with the 3 + 30 + 300 principle. Frequent visitation was primarily associated with relaxation, physical activity, and social interaction. Conversely, only 6% considered that trees cause more damage than benefits, with pavement damage and superficial roots cited as the more significant management challenges. Support for public investment was broad, with over 90% of respondents favouring allocating municipal tax revenues to urban tree management. However, 68% remained unfamiliar with Law No. 59/2021, revealing a gap between public support and policy awareness. These findings establish a national baseline to support municipalities in developing more resilient, inclusive, and health-promoting urban environments in the face of climate change, as they align urban forestry practices with citizens’ expectations. Full article

Background: Autism spectrum disorder (ASD) or psychiatric conditions, special education needs and addictions exert substantial demands on families, yet parental psychological functioning remains insufficiently integrated into prevention and family-based support. An in-depth understanding of parental experiences constitutes a cornerstone of family-centered care, given that parental well-being and resourceful functioning exert a direct and enduring influence on both intervention effectiveness and the broader trajectory of child development. This study aimed at identifying latent parental profiles across clinical and typical developmental contexts. Methods: A total of 281 parents of children with psychiatric diagnoses (primarily ASD), special educational needs, addiction, and typical development were assessed for positive and negative functioning. Latent Profile Analysis (LPA) identified psychological subgroups, followed by Welch’s ANOVA to determine discriminating variables and multinomial logistic regression to examine sociodemographic and contextual predictors. Results: A three-profile solution emerged: Low well-being, high co-dependency and low resource functioning (50%); High well-being, low co-dependency and high resource functioning (26%); and Moderate well-being, moderate co-dependency and moderately resourceful functioning (24%). Parents of children with psychiatric diagnoses were significantly less likely to belong to the High well-being, low co-dependency and high resource functioning profile, underscoring the heightened psychological vulnerability characteristic of this group. Parents of typically developing children tend to belong to Moderate well-being, moderate co-dependency and moderately resourceful functioning. Conclusions: Parental psychological functioning exhibits heterogeneity across developmental contexts. Although parents of children with psychiatric diagnoses revealed the highest vulnerability, the profiles also revealed substantial psychological strain among parents of typically developing children. These findings highlight the need to shift from child-focused to family-centered prevention and support. Full article

Background: Hypertension is one of the most common noncommunicable diseases. Objectives: This research assessed the magnitude of hypertension among young adults, identified its key determinants, and explored potential strategies adopted for prevention. Methods: A cross-sectional design was employed, including 1606 participants aged 18 years and older, recruited through convenience sampling from universities and community settings. Data were collected using a content-validated questionnaire covering sociodemographic information, personal and family medical history, and lifestyle habits. Results: Of the participants, 993 (61.8%) reported hypertension, nearly double previous national estimates. Male gender, age ≥ 30 years, and family history were significant risk factors, along with smoking, alcohol use, sedentary lifestyle, and unhealthy diet, while physical activity and dietary modification were protective. Despite high prevalence, only 22.1% had controlled blood pressure and 17.8% adhered to medication, with 51.5% relying on herbal remedies. Conclusions: These findings highlight the urgent need for early screening, youth-focused awareness, and culturally tailored interventions to reduce hypertension and prevent long-term cardiovascular complications. Hypertension among young adults in the UAE is a major public health concern, requiring integrated strategies combining education, lifestyle modification, and medical management to improve outcomes. Full article