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Search Results (6,134)

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Keywords = socio-demographic factors

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25 pages, 2387 KB  
Article
Clinical, Social, and Healthcare Factors Associated with Nutritional Status in Amyotrophic Lateral Sclerosis: A Multidimensional Approach
by Diogo Sousa-Catita, Paulo Mascarenhas, Cátia Oliveira, Miguel Grunho, Filipe Gonçalves and Jorge Fonseca
Biomedicines 2026, 14(8), 1838; https://doi.org/10.3390/biomedicines14081838 (registering DOI) - 15 Aug 2026
Abstract
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 [...] Read more.
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 R2=0.067; optimism-corrected R2=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
(This article belongs to the Special Issue Pathogenesis and Treatment of Amyotrophic Lateral Sclerosis (ALS))
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15 pages, 702 KB  
Article
Self-Reported Outdoor Activities and Perceived Stress During the First COVID-19 Wave: A Cross-Sectional Study in Poland and Italy
by Jakub Grabowski, Joanna Stępień, Przemysław M. Waszak, Tomasz Michalski, Roberta Meloni, Maja Grabkowska, Aleksandra Macul-Sanewska, Jakub Rojek, Liliana Lorettu, Iwona Sagan, Aleksandra Brzozowska and Leszek Bidzan
Medicina 2026, 62(8), 1564; https://doi.org/10.3390/medicina62081564 - 14 Aug 2026
Abstract
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 [...] Read more.
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
(This article belongs to the Special Issue Mental Illness and Mental Health: Challenges, Trends and Perspectives)
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10 pages, 215 KB  
Article
Assessment of Immunization Levels in Children with Chronic Diseases in a Tertiary Hospital
by Murat Ersoy and Betül Ulukol
Vaccines 2026, 14(8), 704; https://doi.org/10.3390/vaccines14080704 - 14 Aug 2026
Abstract
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 [...] Read more.
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
(This article belongs to the Special Issue Vaccine Epidemiology and Population Health)
22 pages, 580 KB  
Article
Motivation and Perceived Barriers to Physical Activity Among Lithuanian Students: A Cross-Sectional Study
by Dominykas Radišauskas and Aušra Beržanskytė
Medicina 2026, 62(8), 1556; https://doi.org/10.3390/medicina62081556 - 13 Aug 2026
Abstract
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 [...] Read more.
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
(This article belongs to the Section Epidemiology & Public Health)
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20 pages, 746 KB  
Article
Premarital Preventive Examinations and Access to Genetic Counselling in the South-Central Region of Bulgaria: Implications for Preconception and Child Health
by Eleonora Hristova-Atanasova, Teodora Gencheva, Elitsa Gyokova, Georgi Iskrov and Rumen Stefanov
Healthcare 2026, 14(16), 2524; https://doi.org/10.3390/healthcare14162524 - 13 Aug 2026
Abstract
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 [...] Read more.
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
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13 pages, 943 KB  
Article
Patterns and Safety-Related Aspects of Antidepressant and Anxiolytic Use Among Healthcare Students and University Staff at a Brazilian Public University: A Cross-Sectional Study
by Núbia Vieira Alves, Geórgia Almeida Sant’Ana, Jorge Fernando Carrozza, Gabriela Moraes Oliveira, Carlos Ferreira Santos and Adriana Maria Calvo
Pharmacy 2026, 14(5), 118; https://doi.org/10.3390/pharmacy14050118 - 13 Aug 2026
Abstract
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 [...] Read more.
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
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13 pages, 898 KB  
Article
Assessment of Oral Health-Related Quality of Life (OHRQoL) and Factors Influencing Oral Hygiene Habits in Complete Denture Patients
by Alanoud Alotaibi, Zaina Altahiri, Fajer Aljaser, Ghadeer Alenezi, Dena Kayed Ali and Mirza Rustum Baig
Dent. J. 2026, 14(8), 515; https://doi.org/10.3390/dj14080515 - 13 Aug 2026
Viewed by 65
Abstract
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 [...] Read more.
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
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14 pages, 251 KB  
Article
Inpatient Palliative Care for Pediatric Neurologic and Neuromuscular Illnesses in the U.S.—A National Perspective
by Zahra Mojtahedi, Pearl C. Kim, Yonsu Kim, Ji W. Yoo and Jay J. Shen
Children 2026, 13(8), 1072; https://doi.org/10.3390/children13081072 - 13 Aug 2026
Viewed by 63
Abstract
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 [...] Read more.
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
19 pages, 666 KB  
Article
Lumbar Puncture in Saudi Arabia: Evaluating Knowledge, Attitude and Sociodemographic Influences
by Eyad M. Albarrati, Mohammad A. Jareebi, Khalid I. Hakami, Jawaher S. Farji, Reema Nharri, Emtenan A. Mawkili, Ahmed Y. Najmi, Saja A. Almraysi, Mohammed A. Baowideen, Asma A. Jabrah, Yahya H. Khormi, Farjah H. Algahtani, Majed A. Ryani, Ahmed A. Bahri and Ghazi I. Al Jowf
Healthcare 2026, 14(16), 2518; https://doi.org/10.3390/healthcare14162518 - 12 Aug 2026
Viewed by 92
Abstract
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 [...] Read more.
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
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15 pages, 243 KB  
Article
Determinants of Happiness at Work Among Nurses in Prehospital Emergency Care in Portugal: A Cross-Sectional Study
by Sandra Neto, Anabela Afonso, José Magalhães, Márcio Silva and Elisabete Borges
Int. J. Environ. Res. Public Health 2026, 23(8), 1049; https://doi.org/10.3390/ijerph23081049 - 12 Aug 2026
Viewed by 152
Abstract
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 [...] Read more.
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
(This article belongs to the Special Issue Community Health Nursing and Public Health Approach)
18 pages, 274 KB  
Article
Consent to Medical Data Processing Among Adult Primary Care Patients: Associations with Vaccination Behaviour and Healthcare Trust
by Agnieszka Rusiecka, Dorota Stefanicka-Wojtas, Aneta Soll-Morka, Tomasz Hikawczuk, Maria Kasprzyk-Smardz, Monika Zadka, Norbert Zachara, Jarosław Zachara, Stanisław Karol Manulik, Joris van Loenhout, Izabella Uchmanowicz and Donata Kurpas
Healthcare 2026, 14(16), 2505; https://doi.org/10.3390/healthcare14162505 - 12 Aug 2026
Viewed by 62
Abstract
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 [...] Read more.
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
19 pages, 4742 KB  
Article
Mapping High-Altitude Socio-Ecological Assets: Carbon Storage and Habitat Provision Dynamics in the Páramo of Cajas National Park, Ecuador
by Diego Portalanza, Yoansy Garcia, Klever A. Cevallos-Valdez, Javier Del-Cioppo Morstadt, Carlos Ortega and Fanny Rodriguez-Jarama
Land 2026, 15(8), 1450; https://doi.org/10.3390/land15081450 - 12 Aug 2026
Viewed by 172
Abstract
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 [...] Read more.
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
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15 pages, 1093 KB  
Article
Determinants of PrEP Delivery Platform Choice in Adolescents and Young People: The Fast-PrEP Project in Cape Town, South Africa
by Elzette Rousseau, Connor Bondarchuk, Keitumetse Lebelo, Luyanda Matsebula, Fiona Bennin, Pippa Macdonald, Carey Pike, Onesimo Vanto, Ntombovuyo Mathole, Lauren Fynn, Dvora Joseph Davey, Chelsea Coakley, Melissa Wallace and Linda-Gail Bekker
Int. J. Environ. Res. Public Health 2026, 23(8), 1045; https://doi.org/10.3390/ijerph23081045 - 12 Aug 2026
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Abstract
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 [...] Read more.
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
(This article belongs to the Special Issue Advances and Trends in Mobile Healthcare)
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18 pages, 603 KB  
Article
Motivations for Restrictive Dieting and Cognitive Restraint Among Polish University Students
by Mateusz Grajek, Alicja Kozik, Tomasz Jurys and Mateusz Rozmiarek
Nutrients 2026, 18(16), 2625; https://doi.org/10.3390/nu18162625 - 11 Aug 2026
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Abstract
Background: Restrictive dieting is a common behavior among young adults and may be associated with increased vulnerability to disordered eating. University students represent a population potentially exposed to multiple influences affecting eating behaviors, including academic stress, social pressures, and appearance-related standards promoted through [...] Read more.
Background: Restrictive dieting is a common behavior among young adults and may be associated with increased vulnerability to disordered eating. University students represent a population potentially exposed to multiple influences affecting eating behaviors, including academic stress, social pressures, and appearance-related standards promoted through digital media. This study aimed to analyze the relationship between restrictive dietary practices, eating behaviors, and indicators of vulnerability to disordered eating among university students in Poland. Materials and Methods: A cross-sectional study was conducted among 420 university students aged 19–34 years. Data were collected using an anonymous online questionnaire consisting of sociodemographic questions, the original Restrictive Diet Motivation Questionnaire (RDMQ), and the validated Three-Factor Eating Questionnaire-13 (TFEQ-13). Motivational factors were categorized into aesthetic, social, health-related, eating control, and self-discipline, and personal beliefs regarding restrictive dieting. Statistical analyses included the Gamma correlation coefficient, chi-square test, and ordinal logistic regression, with statistical significance set at p < 0.05. Results: Restrictive dieting was reported by a substantial proportion of participants, with women reporting this behavior more frequently than men. The most prominent motivations were related to appearance, weight control, social influences, and personal beliefs regarding restrictive diets. Participants who followed restrictive diets demonstrated higher levels of cognitive restraint compared with those who did not engage in restrictive dieting. Strong associations were observed between cognitive restraint and aesthetic motivations, personal beliefs regarding restrictive dieting, social motivations, eating control and self-discipline, and health-related motivations. Multivariable analysis confirmed that aesthetic motivation, personal beliefs, previous restrictive dieting, and female sex were independent predictors of higher cognitive restraint. Conclusions: Restrictive dieting among university students is strongly associated with appearance-related motives, dieting-related beliefs, and increased cognitive restraint. In this study, eating disorder risk was inferred from behavioral indicators, particularly cognitive restraint, rather than from clinical diagnostic criteria. These findings highlight the need for preventive strategies promoting evidence-based nutrition knowledge, healthy eating behaviors, and a positive body image among young adults. Full article
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13 pages, 385 KB  
Article
Perceived Stress, Type D Personality and Coping Strategies Among Hospitalized Oncology Patients: A Cross-Sectional Study
by Robert Jan Łuczyk, Kamil Sikora, Agnieszka Zawada, Marta Łuczyk, Dorota Weber and Anna Charuta
J. Clin. Med. 2026, 15(16), 6213; https://doi.org/10.3390/jcm15166213 - 11 Aug 2026
Viewed by 162
Abstract
Background: Stress is regarded as one of the natural and unavoidable elements of human life and, at the same time, one of the key determinants of physical and mental health. Stress is not a new phenomenon; it has accompanied human beings since the [...] Read more.
Background: Stress is regarded as one of the natural and unavoidable elements of human life and, at the same time, one of the key determinants of physical and mental health. Stress is not a new phenomenon; it has accompanied human beings since the beginning of life as a reaction to everyday challenges. This study aimed to assess the prevalence and severity of stress, as well as stress-coping strategies, in a group of patients treated for oncological reasons. Methods: The study included 108 patients hospitalized at the Independent Public Clinical Hospital No. 1 in Lublin, Poland, in the following departments: the 2nd Department of General, Gastroenterological and Gastrointestinal Oncological Surgery; the Department of Oncological Surgery; and the Department of Hemato-Oncology and Bone Marrow Transplantation. Three standardized questionnaires were used: the Perceived Stress Scale (PSS-10), the Type D Personality Scale (DS-14), and the “How Do I Cope” Inventory (JSR). Statistical analysis was performed with IBM SPSS Statistics, version 25; statistical significance was set at α < 0.05. Results: Patients treated for oncological reasons constitute a group exceptionally exposed to stress, which accompanies them at every stage of the disease, from diagnosis, through treatment, to the terminal phase. In patients whose treatment resulted in remission, stress related to the possibility of recurrence accompanies every follow-up examination and every worrying symptom. Given the range of situations that provoke stress, the overall level of stress in this group can be regarded as high. Stress-coping strategies among oncological patients are shaped by multiple factors, including selected sociodemographic characteristics; taking into account the diversity of these factors, coping strategies varied considerably across the sample. The level of coping strategies was not associated with age or sex but was significantly associated with educational attainment. Conclusions: Oncological patients experience a high and pervasive level of stress that persists throughout diagnosis, treatment, and follow-up. Stress-coping strategies are heterogeneous, are not determined by age or sex, but are shaped by education, indicating a need for individualized psychosocial and educational support integrated into routine oncological care. Full article
(This article belongs to the Section Mental Health)
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