Search Results (6,136)

Depression has become a major concern for educational institutes due to its increasing incidence and detrimental impacts on students’ well-being. However, its global prevalence in the context of tertiary education remains unclear. This umbrella review summarised existing meta-analyses and systematic reviews to examine the worldwide prevalence of depression among university students. Several sociodemographic and methodological factors, including differences in depression prevalence before, during, and after COVID-19, were examined as moderators. Structured and exhaustive searches were conducted in five bibliographic databases and five journals, alongside two sources of grey literature. A total of 61 meta-analyses and systematic reviews were included in the final synthesis. Review-level sample sizes ranged from 823 to 8,238,954 (Mdn = 24,047), covering all inhabited continents and a broad range of countries across high-, middle-, and low-income settings. The global median prevalence of depression across the included reviews was 32.00%, with reported estimates ranging from 11.00% to 63.00%. Analysis of specific populations highlighted greater vulnerability among female students and those studying in Asia compared to Europe. The pandemic was shown to have contributed to the increase in depression prevalence among university students. Given this high prevalence of depression, there is an imperative need for educational institutions to prioritise mental well-being. Full article

Background: Forensic concepts should be guided by current evidence. However, there is currently a lack of even basic information on individuals who have committed a criminal offence in relation to a mental disorder in Germany. Methods: The CONNECT project aims to add knowledge on this patient group by conducting an annual survey of all forensic psychiatric hospitals in Germany. The resulting database will include comprehensive clinical, legal and socio-demographic data. The project aims are (a) to offer a much-needed overview of the sociodemographic, clinical, offending and treatment data of this group, (b) to identify predicting factors associated with leave status and discharge, and (c) to establish rates of reconviction and its predictors at a three-year follow-up. Results: This contribution examines the procedures and obstacles associated with the establishment of the survey. These include concerns about data protection, the necessity of engaging and persuading the ministries of each federal German state, and the scarcity of resources within hospitals, as well as hospital organization and communication. The objective is to foster an understanding of the implementation of a national reference date survey. Conclusions: It is anticipated that this project will have a substantial impact within clinical and academic contexts, while also offering value to policymakers and care providers. Full article

Background: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease where malnutrition significantly worsens clinical outcomes. We performed a multidimensional analysis to identify clinical, social, and healthcare factors associated with nutritional vulnerability in a real-world setting. Methods: This cross-sectional study included 97 adults with ALS recruited through a national association (APELA) and a hospital-based outpatient consultation (ANOC). Nutritional status was assessed using the Mini Nutritional Assessment (MNA^®), Body Mass Index (BMI), and Global Leadership Initiative on Malnutrition (GLIM) criteria. Associations with total MNA^® scores were evaluated using a prespecified multivariable linear model with HC3 robust standard errors and bootstrap validation to assess inferential stability. Results: Malnutrition prevalence was high, with 42.3% of participants classified as moderately malnourished and 43.3% as severely malnourished under GLIM criteria. Mean MNA^® score was 19.69 (SD 4.53). In the adjusted model, ANOC recruitment was associated, after adjustment, with a 4.477-point lower MNA^® score compared with APELA (HC3 95% CI −7.071 to −1.884; $p<0.001$). Other sociodemographic and clinical factors yielded imprecise estimates. Although explanatory power was modest (Adjusted $R^2=0.067$; optimism-corrected $R^2=-0.005$), the recruitment setting remained a robust correlate across sensitivity analyses. Conclusions: Recruitment setting emerged as the most consistent adjusted correlate of MNA^® scores, likely reflecting differences in clinical case mix and referral pathways in the Portuguese healthcare context. These findings highlight nutritional vulnerability in ALS as a multifaceted construct that should be interpreted in relation to both clinical and healthcare-contextual factors. This study supports considering systemic factors and the need for longitudinal research that incorporates comprehensive functional and social metrics to optimize multidisciplinary nutritional interventions. Full article

Background and Objectives: The COVID-19 pandemic and the accompanying containment measures substantially altered everyday life and created conditions that could intensify psychological distress. Physical activity is widely recognized as a factor supporting mental well-being, yet less is known about whether specific forms of outdoor activity were associated with perceived stress during the first pandemic wave. This study aimed to assess the relationship between selected forms of outdoor physical activity and perceived stress during the COVID-19 pandemic among residents of Poland and Italy. Materials and Methods: This cross-sectional analysis was based on data collected within a previously published multinational survey conducted during the first wave of the COVID-19 pandemic. The study included respondents from Poland and Italy and examined PSS scores in relation to three broad self-reported agreement items concerning walking in public places, walking in the neighborhood, and outdoor sports such as running or cycling. Responses were analyzed in their original categories and were additionally dichotomized as agreement versus disagreement. Non-parametric tests were used for unadjusted comparisons, and multivariable logistic regression adjusted for country and sociodemographic and health-related factors. Results: In unadjusted analyses, respondents who agreed that they walked in public places or engaged in outdoor sports had lower mean PSS scores than those who disagreed (20.40 vs. 21.61 and 20.59 vs. 21.70, respectively; both p < 0.001). Respondents who agreed that they walked in their neighborhood had a slightly higher mean PSS score than those who disagreed (21.76 vs. 21.26; p = 0.018). After correction of the dichotomized activity variables, none of the three outdoor activity measures were independently associated with high perceived stress in the adjusted model. Conclusions: Self-reported walking in public places and outdoor sports were associated with lower PSS scores in unadjusted comparisons, whereas neighborhood walking showed a small association in the opposite direction. None of the three broad activity measures were independently associated with high perceived stress after adjustment. Because the study was cross-sectional and outdoor activity was assessed using simple agreement statements rather than frequency, duration, or intensity measures, these findings should be interpreted cautiously and do not support causal conclusions. Full article

Background/Objective: Vaccination is one of the most effective and cost-effective preventive health measures for preventing infectious diseases. The literature reports that children with chronic illnesses have lower vaccination rates than healthy children and are at higher risk for preventable diseases. This study aimed to determine the immunization status of children with chronic illnesses, assess vaccination rates, and help raise awareness on this issue. Material/Method: Children aged 1 month to 18 years who presented to or were admitted to the Pediatric Clinic of Mersin City Education and Research Hospital between 1 March and 30 June 2024, and who were followed up for their chronic illness, and whose parents gave their consent, were included in the study. Sociodemographic data and information about routine and vaccines outside the national immunization schedule (Rotavirus, meningococcal, HPV, Influenza) were obtained from the parents. The status of vaccination of disease-specific recommended vaccines was also recorded. Results: A total of 256 children were included in the study (mean age 8.7 ± 4.69 years; 42.2% girls). A high rate of complete vaccination according to the routine vaccination schedule was observed. However, non-routine vaccinations were administered at low rates: rotavirus 9%, meningococcal 4.7%, and influenza 12.2%. The HPV vaccine was administered to only one patient in the study group. Recommended vaccines for the disease were administered to only 16.4% of eligible children. Conclusions: Children with chronic illnesses are at high risk for infection and complications. Increasing vaccine awareness among both healthcare professionals and parents will contribute to higher immunization rates. Comprehensive studies are needed to identify factors influencing vaccination in this population. Full article

Background and Objectives: Regular physical activity is important for students’ health and well-being, but participation may be influenced by motivation and perceived barriers. This study assessed physical activity levels, motivational regulation, perceived barriers, and their associations among students enrolled in Lithuanian higher education institutions. Materials and Methods: A cross-sectional survey was conducted among 370 students. The questionnaire assessed weekly physical activity, motivational regulation, perceived barriers, and sociodemographic characteristics. Group comparisons and exploratory hierarchical multivariable logistic regression were performed. Results: Overall, 74.6% of the participants met the World Health Organization physical activity recommendations. In separate analyses, male participants and those from major cities were more likely to meet the World Health Organization physical activity recommendations. Intrinsic and identified regulation were the most prominent motivational factors, whereas lack of energy, lack of willpower, and lack of time were the most frequently reported barriers. In the final model, higher intrinsic regulation was associated with greater odds of meeting the recommendations (odds ratio 1.64, 95% confidence interval 1.10–2.44), while lack of willpower (odds ratio 0.34, 95% confidence interval 0.19–0.60) and lack of time (odds ratio 0.35, 95% confidence interval 0.18–0.68) were associated with lower odds. Sociodemographic characteristics were not statistically significant in the final model. Conclusions: Most participants in this sample met the World Health Organization physical activity recommendations. The findings highlight the relevance of intrinsic regulation and selected perceived barriers to physical activity participation. These exploratory associations may help guide future longitudinal and intervention research on context-specific physical activity promotion in higher education. Full article

Background: Premarital medical certification is required before civil marriage in Bulgaria, but little is known about how newly married couples perceive this process within the broader framework of preconception care and genetic counselling. This study examined couples’ perceptions of premarital preventive examinations, reported receipt of genetic counselling, preferred counselling providers, and associated sociodemographic factors. Methods: A cross-sectional online survey was conducted between 2023 and 2025 among a convenience sample of 623 newly married heterosexual couples residing in the South-Central Region of Bulgaria. Each couple jointly completed a study-specific questionnaire assessing perceptions of premarital medical examinations, sources of preconception information, preferred counselling providers, and reported receipt of genetic counselling. Two multivariable binary logistic regression models were fitted to examine factors independently associated with reported receipt of genetic counselling and affirmative support for the necessity of premarital medical examination. Results: Overall, 77.8% of couples considered the premarital medical examination necessary, whereas 57.1% perceived it as primarily formal and 38.5% reported having received genetic counselling. Family (90.6%) and school (63.8%) were identified as responsible sources of preconception information more often than general practitioners (19.6%). In the adjusted model, each additional year of female age was associated with lower odds of reported genetic counselling receipt (aOR = 0.929, 95% CI: 0.900–0.959, p < 0.001). Bulgarian ethnicity was also associated with lower odds of reported counselling receipt compared with non-Bulgarian ethnicity (aOR = 0.499, 95% CI: 0.291–0.856, p = 0.012). Female age (aOR = 1.043, 95% CI: 1.006–1.081, p = 0.021) and employment (aOR = 1.847, 95% CI: 1.109–3.076, p = 0.018) were associated with affirmative support for the necessity of premarital medical examination. Conclusions: The findings describe perceptions and reported experiences within a regional online convenience sample and should not be interpreted as causal evidence or as a direct assessment of healthcare-system performance. They indicate areas warranting further evaluation, including the organisation of genetic counselling, the role of primary care, and equitable access to comprehensive preconception services. Full article

Background/Objectives: The use of antidepressants and anxiolytics has increased worldwide, raising concerns about treatment patterns, medication safety, and rational use. This study aimed to characterize the frequency, utilization patterns, and safety-related aspects of antidepressant and anxiolytic use among healthcare students and university staff at a Brazilian public university. Methods: A cross-sectional study was conducted between September 2024 and June 2025 using an online questionnaire administered to students and staff at the University of São Paulo, Brazil. Descriptive statistics and multivariable logistic regression were applied to characterize medication utilization patterns and evaluate factors associated with antidepressant and/or anxiolytic use. Results: Among the 300 participants, 167 (55.7%) reported antidepressant and/or anxiolytic use during the previous six months. Most users reported treatment for more than one year (59.9%), anxiety as the primary indication (68.3%), and prescription by a healthcare professional (93.4%). A total of 203 medications were reported, with selective serotonin reuptake inhibitors being the most common pharmacological class (42.4%). Among users, 99 (59.3%) reported at least one self-reported adverse effect, most commonly excessive drowsiness, reduced libido/sexual dysfunction, dry mouth, headache, and nausea. No statistically significant independent associations were identified between antidepressant and/or anxiolytic use and the evaluated sociodemographic characteristics. Conclusions: Antidepressant and anxiolytic use was frequently reported and was characterized by predominantly long-term, professionally prescribed treatment and frequent self-reported adverse effects. These findings may inform institutional strategies to improve access to mental healthcare while promoting the rational and safe use of psychotropic medications within university settings. Full article

Objectives: This study aimed to investigate the sociodemographic factors influencing oral hygiene habits and oral health-related quality of life (OHRQoL) among complete denture wearers at Kuwait University Dental Clinic (KUDC). Methods: A cross-sectional observational study was conducted using a self-administered questionnaire and an Oral Health Impact Profile-19 (OHIP-19) instrument to assess oral hygiene habits and OHRQoL in 61 complete denture patients, treated by dental undergraduate students at KUDC, between January 2019 and December 2023. Additionally, a clinical assessment of denture hygiene was performed using the Budtz-Jörgensen denture plaque index for all patients (n = 61). Sociodemographic, general health status, oral hygiene habits, and OHRQoL-related data were collected. Results: A total of 37.7% of included participants were aged 51–60 years, with 75.4% being male. Most participants (81.96%) had a high school education or less. Caries was reported as the primary cause of tooth loss (83.6%), and 77.04% recorded irregular dental visits. Only 46.05% of participants demonstrated optimal and/or good denture hygiene. Toothpaste was the most common cleaning method (79.21%), and 70.62% removed their dentures at night. A significant association was found between education level and denture wearing (p = 0.035), as well as between gender and the frequency of dental visits (p = 0.024). However, no significant relationship was observed between gender and denture hygiene (p = 0.52). The OHIP-19 results revealed that poor denture hygiene impacted OHRQoL across multiple domains, including functional limitation, physical pain, psychological discomfort, and social disability. Conclusions: Unsatisfactory denture hygiene was prevalent among participants, possibly due to limited awareness or inadequate instructions provided by dental health practitioners. Education level and gender influenced certain aspects of denture care, highlighting the need for targeted oral health education programs and improved patient guidance from dental practitioners. Additionally, poor denture hygiene was associated with reduced OHRQoL, emphasizing the importance of addressing both oral hygiene practices and their psychosocial impacts to improve overall well-being. Full article

Background: Pediatric neurologic and neuromuscular illnesses, often progressive and debilitating, require comprehensive medical management focused on enhancing quality of life. Despite the benefits of palliative care in managing symptoms and providing psychological support, there is limited knowledge on its associated factors and utilization for pediatric neurologic and neuromuscular illnesses in hospital settings. Methods: This study analyzed the National Inpatient Sample (NIS) database, covering hospitalizations of children under 18 years with neurologic and neuromuscular diagnoses from 2016 to 2020, to examine associations of palliative care with sociodemographic, clinical, and hospital factors. Results: Out of 139,598 pediatric patients, 4273 (3.1%) received palliative care. Palliative care recipients were younger (mean age 5.3 vs. 6.4 years), had more diagnoses (17.8 vs. 10.9) and procedures (4.0 vs. 2.4), higher illness severity scores (3.4 vs. 2.6), longer LOS (18.7 vs. 9.9 days), and higher hospital charges ($332,559 vs. $150,727). In-hospital mortality was significantly higher among palliative care recipients (32.9% vs. 2.4%). The utilization of palliative care increased annually (OR = 1.08, 95% CI [1.05, 1.11]). Black patients had lower odds (OR = 0.90, 95% CI [0.81, 1.00]). Higher severity scores (OR = 2.09, 95% CI [1.99, 2.20]) were positively associated with palliative care. Smaller hospitals and urban nonteaching hospitals were inversely associated with palliative care utilization. Conclusions: Palliative care utilization for pediatric neurologic and neuromuscular illnesses remains low, with significant disparities based on sociodemographic and hospital-related factors. Enhanced awareness and integration of palliative care in pediatric practice, especially in underutilized settings, are crucial for improving outcomes and quality of life for these patients. Full article

Background/Objectives: Lumbar puncture (LP) is an essential diagnostic and therapeutic procedure in neurological practice. Despite its clinical value, misconceptions and fear may influence its acceptance among the public. This study aimed to assess knowledge, attitudes, and misconceptions regarding LP among adults in Saudi Arabia and to examine associated sociodemographic factors. Methods: A cross-sectional study was conducted between June 2025 and January 2026 using a structured, self-administered online questionnaire adapted from a previously validated instrument. Adults aged ≥18 years residing in Saudi Arabia were recruited via convenience sampling through open social media channels, so the sample is self-selected rather than population-representative. Knowledge and attitude scores were categorized into defined levels, and multivariable regression analyses were performed to identify independent predictors. Results: A total of 1267 participants were included. Knowledge of LP was limited (mean 6.1 ± 3.9 of 18), with 905 (71%) scoring poor and only 362 (29%) demonstrating good knowledge; misconceptions about complications such as urinary incontinence and erectile dysfunction were common. Attitudes appeared favorable, with 1182 (93%) reaching the pre-specified 50% threshold, but this cut-off is lenient because an entirely neutral respondent scores 60% on a summed five-point scale, and only 692 (55%) agreed they would sign consent if their physician recommended LP. Knowledge and attitude were weakly but significantly related (r = 0.21, 95% CI 0.16 to 0.26; adjusted β = 0.25 per additional correct item, p < 0.001). Higher education, student status, healthcare occupation, and higher income predicted better knowledge, and male sex predicted lower knowledge (all p < 0.05), whereas sociodemographic factors were weakly associated with attitude. Conclusions: Among self-selected online respondents in Saudi Arabia, knowledge of lumbar puncture was limited while attitudes were comparatively favorable, and the two were weakly but positively related. Targeted educational interventions are warranted to address misconceptions, enhance public awareness, and support informed decision-making within the healthcare system. Full article

Happiness at work is an important factor associated with nurses’ wellbeing, performance, retention, and quality of care. However, evidence on workplace happiness among nurses working in prehospital emergency care remains scarce, despite the emotional demands and complexity of this setting. This study aimed to analyse overall happiness at work and its dimensions—engagement, job satisfaction, and affective organisational commitment—among nurses working in prehospital emergency care in Portugal and to identify associated sociodemographic and professional factors. A cross-sectional observational, correlational study was conducted between June and July 2025 with 103 nurses working in Portuguese prehospital emergency services. Data were collected using a sociodemographic and professional questionnaire and the Short Happiness at Work Scale. Descriptive statistics, Student’s t-test, one-way analysis of variance, and stepwise multiple linear regression were performed. Participants reported moderate levels of happiness at work (M = 4.91; SD = 0.96). Engagement had the highest mean score (M = 5.42; SD = 1.20), whereas job satisfaction had the lowest (M = 4.04; SD = 1.16). Leisure activities outside work were statistically associated with higher happiness at work. These findings should be interpreted in light of the cross-sectional design and convenience sampling, and suggest that strategies promoting wellbeing, work–life balance, and psychological recovery may contribute to occupational health among prehospital emergency nurses. Full article

Background: The secondary use of routinely collected medical data is increasingly important for healthcare research and public health. However, the validity and representativeness of consent-based datasets depend on patients’ willingness to allow their medical information to be used. Although vaccination behaviour and trust in healthcare systems have both been extensively studied, little is known about their relationship with consent to medical data processing. Objective: This study aimed to identify factors associated with consent to medical data processing among adult primary care patients, with particular emphasis on vaccination status, vaccination attitudes, information-seeking behaviours, and trust-related factors. Methods: A cross-sectional study was conducted among 921 adult patients recruited from three primary healthcare centres in Poland representing different organizational and geographical settings. Data were collected using a standardized questionnaire. The primary outcome was participants’ consent to the transfer of vaccination-history data (yes/no), referred to throughout the manuscript as “consent to medical data processing”. Associations between consent status and socio-demographic characteristics, vaccination-related attitudes, information sources, and trust-related factors were assessed using chi-square tests and non-parametric methods. Hierarchical multivariable logistic regression models were constructed to identify factors independently associated with consent. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), Nagelkerke’s R², and the Hosmer-Lemeshow goodness-of-fit test. Results: Overall, 565 participants (61.3%) provided consent to medical data processing and 356 (38.7%) declined consent. Among participants who provided consent, 88.5% were classified as vaccinated, compared with 69.1% among those who did not provide consent (p < 0.001). In multivariable analyses, vaccination status remained independently associated with consent across all hierarchical models. The fully adjusted model showed that vaccinated participants had more than twice the odds of providing consent compared with unvaccinated individuals (OR = 2.27; 95% CI: 1.32–3.92; p = 0.003). Older age was also positively associated with consent (OR = 1.02 per year; 95% CI: 1.01–1.03; p = 0.004). Significant and persistent differences were observed between healthcare centres, suggesting that organizational and contextual factors may play an important role. By contrast, vaccination attitudes, trust in the healthcare system, perceived accessibility of vaccination information, and information-source were not independently associated with consent after adjustment. The final model demonstrated good discrimination (AUC = 0.892), satisfactory calibration (Hosmer–Lemeshow p = 0.647), and moderate explanatory power (Nagelkerke’s R² = 0.557). Conclusions: Consent to medical data processing was independently associated with vaccination status and healthcare centre among adult primary care patients. The findings suggest that vaccination behaviour and organizational context are important correlates of consent to medical data processing. Organizational characteristics may also play an important role in shaping consent behaviour in healthcare settings. Researchers using consent-based medical data should consider the potential impact of differential consent behaviour on the representativeness of study populations. Further research is needed to understand contextual and behavioural determinants of consent to medical data processing. Full article

High-altitude Andean páramo ecosystems are critical socio-ecological assets that provide key regulating and supporting services, yet they remain highly vulnerable to climate change and anthropogenic pressures. Understanding these services requires frameworks that integrate biophysical capacity with social valuation and demographic accessibility. In this study, we mapped and assessed belowground and aboveground carbon storage and species habitat provision across the altitudinal gradient (3160–4400 m.a.s.l.) of Cajas National Park (PNC), Ecuador, using a spatially explicit socio-ecological approach. Carbon stocks were modeled following The Intergovernmental Panel on Climate Change (IPCC) 2019 Refined Guidelines, combining reference soil organic carbon (SOC) stocks with aboveground biomass coefficients. Habitat provision was modeled through a multi-factor suitability index integrating Normalized Difference Vegetation Index (NDVI), elevation, water bodies, and interpolated climate surfaces. Biophysical supplies were weighted via a Delphi-based expert consultation and integrated with demographic census data (173,672 inhabitants in four adjacent parishes) to estimate actual service capture and effective benefits. Total carbon stocks in PNC were estimated at 1.49 million Mg C, with volcanic Andisols acting as the primary reservoir (97.5% of the total stock). Habitat suitability was highly heterogeneous, with critical refuge patches clustered around the park’s lacustric network and stable microclimatic zones. Socio-ecological mapping revealed that the eastern boundary of the park represents the highest hotspot of effective benefit capture, directly supplying vital water regulation and cultural services to the peri-urban populations of Sayausí and Baños. These results demonstrate the utility of integrating standard IPCC guidelines with the ECOSER protocol, offering a repeatable and transparent framework to guide spatial conservation planning and sustainable land-use zoning in vulnerable high-altitude protected areas. Full article

Background: Effective HIV prevention in South Africa requires implementing pre-exposure prophylaxis (PrEP) service delivery options responsive to adolescents and young people (AYP) with diverse characteristics and needs. We aimed to identify characteristics associated with AYP’s choice of PrEP initiation setting. Methods: Fast-PrEP is an ongoing phase 4 HIV prevention programme in Cape Town, South Africa. Oral PrEP (TDF/FTC) is offered to AYP (15–29 years) within sexual and reproductive health services from four community-based mobile clinics and 12 public primary healthcare facilities. Descriptive statistics and logistic regression models evaluated sociodemographic, behavioural, and clinical factors associated with PrEP initiation from mobile clinics and public health facilities in 13,807 AYP between Aug’22 and Dec’24. Results: Most AYP (70.7%; n = 9760) initiated PrEP from mobile clinics. AYP with more complex healthcare needs, such as pregnancy, parenthood, known sero-different relationships, or currently having STI symptoms, were significantly more likely to use the public health facilities. Both male and female AYP initiating PrEP at mobile clinics had four times the odds of moderate-to-severe depression. Previous PrEP experience was not associated with the choice of PrEP service delivery platform. Conclusions: Our results indicate that offering community-based PrEP alongside public sector facilities increases the reach of a diverse group of AYP who may benefit from PrEP. Full article