Search Results (744)

The increased global prevalence of inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), is a chronic relapsing inflammatory condition of the gastrointestinal tract that creates a substantial socioeconomic burden. Existing pharmacotherapeutic treatments primarily target inflammatory signaling cascades and have disadvantages because of the side effects of drugs, reduced long-term efficacy, and high cost, necessitating the development of safe and sustainable adjunctive therapies. This review synthesizes mechanistic advances regarding dietary polysaccharides as bioactive agents that may have the capacity to induce remodeling of inflamed gastrointestinal tract in colitis and could be an adjunctive strategy as functional food ingredients due to their various biological activities in the management of colitis. Polysaccharides alleviate colitis through several interconnected pathways. First, they correct the gut dysbiosis by enriching beneficial taxa such as Lactobacillus, Bifidobacterium, and Akkermansia muciniphila. Second, fermentation of polysaccharides produces short-chain fatty acids (SCFAs), particularly butyrate, which serve as the primary energy source for colonocytes. Third, they restore intestinal barrier integrity by upregulating tight junction proteins such as ZO-1, occludin, and claudin, also performing pro-inflammatory cascade inhibition and elimination of oxidative stress via Nrf2/HO-1 activation The relationship between structural properties of polysaccharides based on molecular weight, monosaccharide composition, and biological functions of chemically modified dietary polysaccharides in colitis is studied. Dietary polysaccharides are explored here not as replacements for pharmacotherapy but as potential adjunctive or functional food-based interventions that may complement existing treatments as safe, multitargeted, and cost-effective interventions in prevention or long-term management of colitis and IBD. This review presents dietary polysaccharides function not as passive dietary fibers but as bioactive, multi-targeted, structurally dependent agents capable of restoring intestinal homeostasis, suggesting them as potentially safe, adjunctive interventions. Full article

Background/Objective: Parental feeding practices play an important role in shaping children’s dietary intake, eating behaviours, and long-term health outcomes. Although several questionnaires assess feeding practices, few have been validated among socioeconomically disadvantaged populations, despite these groups being disproportionately affected by food insecurity and diet-related health inequities. This study assessed the structural validity and internal consistency of the Feeding Practices and Structure Questionnaire—Solid Feeding version (FPSQ-S)—among socioeconomically disadvantaged mothers and fathers of young children. Methods: Two cross-sectional online surveys were conducted with 178 mothers and 94 fathers of children aged 5–35 months living in disadvantaged households. Confirmatory factor analysis was used to examine the structural validity of the FPSQ-S. Internal consistency was assessed using Cronbach’s alpha and Hancock’s H coefficients. Results: The original six-factor FPSQ-S structure was retained and demonstrated acceptable overall model fit in this disadvantaged sample (CFI = 0.846, TLI = 0.821, RMSEA = 0.070). Internal consistency ranged from acceptable to excellent across subscales (Cronbach’s α = 0.63–0.93; Hancock’s H = 0.64–0.93). Most items loaded satisfactorily onto their intended constructs; however, two items within the Feeding on Demand construct demonstrated weak factor loadings, and this construct showed lower reliability than the remaining subscales Conclusions: This is the first study to evaluate the FPSQ-S among socioeconomically disadvantaged mothers and fathers of children aged 5–35 months. The FPSQ-S demonstrated acceptable structural validity and reliability. While the six-factor structure was largely supported, further refinement of the Feeding on Demand construct and additional psychometric evaluation are warranted. Full article

Obesity and dental caries are highly prevalent chronic conditions with significant global health impact. Although an association between these diseases has been suggested, the nature of this relationship remains unclear. This state-of-the-art review aims to synthesize current evidence on the interplay between obesity and dental caries, focusing on shared risk factors, salivary alterations and underlying biological mechanisms. Evidence indicates that obesity and dental caries share common behavioral and socioeconomic determinants, namely unhealthy dietary patterns with high intake of free sugars, poor oral hygiene habits and social disadvantage. Salivary alterations observed in obesity may also create a more cariogenic oral environment. Additionally, inflammatory mediators, oxidative stress markers and changes in the oral microbiome suggest biologically plausible links between both conditions. However, current data does not support a direct causal relationship, but rather a complex multifactorial interaction between obesity and dental caries driven by shared risk factors and modifiable behaviors. Preventive strategies should adopt an integrated approach targeting shared determinants, particularly diet, oral hygiene habits and socioeconomic status. Nevertheless, the predominance of cross-sectional evidence limits causal inference, highlighting the need for longitudinal studies that simultaneously assess obesity and dental caries, and that address salivary biomarkers using standardized methodologies across different age groups to clarify underlying mechanisms and assess their clinical relevance. Full article

This study investigates place-based barriers to initial teacher training (ITT) recruitment in rural-coastal regions of England, focusing on Cornwall as a case study. Utilizing semi-structured interviews with nine ITT provider leaders and nine trainee teachers, the research applies the concept of educational isolation to ITT providers in areas that are geographically remote, socioeconomic disadvantaged, and culturally isolated. The analysis is framed by the critical pedagogy of place and social capital theory, moving beyond deficit-based interpretations of rurality to critically examine how place-based inequities are produced through urban-normative policy and resource allocation. Primary data were analyzed using reflexive thematic analysis. Four substantive themes emerged: transport dependency and accessibility constraints that structurally exclude lower-income and disabled trainees; housing displacement driven by the tourist economy, which compounds financial insecurity; an “employment precarity problem” where localized primary school oversaturation coexists with secondary teacher shortages; and cultural and professional isolation that disproportionately impacts ethnically diverse trainees in demographically homogeneous communities. The research further identifies that community resilience, while enabling individuals to navigate structural barriers, can obscure infrastructural inadequacy and diminish impetus for systemic policy reform. This paper contributes to international scholarship on spatial justice and rural teacher education by presenting an integrated conceptual framework with transferable relevance to similar rural-coastal and peripheral contexts globally and by offering policy recommendations for place-weighted ITT funding, infrastructure investment in educationally isolated areas, and the development of collaborative provider models. Full article

Background: Prostate cancer remains one of the most prevalent malignancies and a leading cause of cancer-related mortality among men in the United States, with more than 300,000 new cases diagnosed annually. As the burden of disease continues to rise, ensuring equitable access to effective treatment remains a critical public health priority. Unequal access to definitive surgical management among disadvantaged populations may contribute to preventable morbidity and mortality. Radical prostatectomy is a cornerstone treatment for localized disease; however, its utilization has evolved over time in response to changing screening guidelines, technological advancements, and shifting treatment paradigms. Despite these developments, disparities in access to surgical management persist. Methods: Using the Surveillance, Epidemiology, and End Results database, we conducted a retrospective cohort study evaluating factors associated with radical prostatectomy utilization among 917,194 men with localized or regional prostate cancer diagnosed between 2004 and 2022. Multivariable logistic regression assessed demographic, socioeconomic, and clinical predictors of surgical treatment. Results: Overall, 33.5% of patients underwent radical prostatectomy. Increasing age was strongly associated with lower odds of surgery (OR 0.904 per year, 95% CI 0.903–0.904, p < 0.001), while married patients were significantly more likely to undergo prostatectomy (OR 1.601, 95% CI 1.554–1.649, p < 0.001). Black patients had markedly lower odds of surgery compared with White patients (OR 0.547, 95% CI 0.539–0.555, p < 0.001), whereas Asian/Pacific Islander patients had slightly higher odds (OR 1.082, p < 0.001). More recent year of diagnosis and increasing income were associated with modest reductions in prostatectomy utilization. Conclusions: These findings demonstrate that treatment selection in prostate cancer is influenced not only by disease characteristics but also by sociodemographic factors, highlighting persistent disparities in access to definitive surgical care and the need for targeted interventions to improve equity in treatment delivery. Full article

Background/Objectives: Mental health problems among university students represent a growing public health concern and are shaped by both psychological and socioeconomic determinants that may act independently and interactively. This systematic review aimed to evaluate the separate and combined effects of these determinants on depression, anxiety, stress, and psychological distress in higher education students. Methods: A structured and targeted search strategy using predefined keyword groups and Boolean combinations across PubMed, Scopus, Web of Science, and Google Scholar identified 99 records, of which 19 duplicates were removed. After screening 80 titles and 52 abstracts, 34 full-text articles were assessed for eligibility, and 30 studies were ultimately included in the final review. Data were extracted on study characteristics, mental health outcomes, psychological determinants, socioeconomic factors, and their interactions. Results: The included studies consistently showed that psychological factors, including resilience, coping strategies, loneliness, self-efficacy, and perceived control, were associated with mental health outcomes, with higher resilience and self-efficacy linked to lower levels of depression and anxiety, and maladaptive coping and loneliness associated with increased psychological distress. Socioeconomic determinants, including financial stress, low socioeconomic status, parental education, housing insecurity, and food insecurity also independently contributed to elevated risks of depression, anxiety, and stress. Importantly, several studies demonstrated an interaction between these domains, where socioeconomic disadvantage amplified the adverse effects of poor coping capacity, low resilience, and social isolation, whereas social support and adaptive coping mitigated these effects. Conclusions: Student mental health is influenced by both distinct and interacting psychological and socioeconomic mechanisms, emphasizing the need for integrated institutional strategies that address structural vulnerabilities alongside individual psychological resilience. Full article

Background/Objectives: Tooth loss reflects cumulative biological and social processes across the life course. However, population-level causal evidence on the influence of structural social vulnerability and multimorbidity on tooth-loss severity remains limited in middle-income contexts. This study evaluated the causal impacts of social vulnerability and multimorbidity on tooth-loss severity in Chilean adults under explicit potential-outcomes assumptions. Methods: We analyzed nationally representative data from the Chilean National Health Survey 2016–2017 ($N=5165$ adults aged ≥20 years with oral examination; analytic sample $n=4521$). Outcomes comprised ordinal severity ($y_1$: functioning dentition, moderate loss, severe loss, edentulism) and continuous tooth count ($y_2$). Exposures included a Social Vulnerability Index (SVI, 0–1) and Multimorbidity Score (MS, 0–1). We estimated confounder-adjusted proportional-odds and survey-weighted linear regression models. Population-averaged causal contrasts were obtained via g-computation comparing 75th and 25th exposure percentiles, with 95% confidence intervals from probability-proportional-to-size bootstrap (1000 replications). Age-dependent edentulism trajectories were generated using discrete-time Markov projections. Results: In the weighted population, 72.6% retained functional dentition, whereas 5.5% were edentulous. Increasing SVI from 0.091 to 0.345 was associated with a 0.110-point severity increase and 1.95 fewer teeth. Increasing MS from 0.00 to 0.20 was associated with a 0.062-point severity increase and 1.20 fewer teeth. SVI showed larger population-averaged effects than multimorbidity. Conclusions: Within a potential-outcomes framework and under the stated identifying assumptions, structural social vulnerability and multimorbidity each exerted independent effects on tooth-loss severity, with socioeconomic disadvantage showing the stronger distributional gradient across the life course. Because the data are cross-sectional, this causal interpretation is conditional on those assumptions rather than established by the design. Full article

Background and Objectives: Child dental neglect is a clinically significant form of maltreatment that frequently reflects broader challenges related to caregiving within the family environment. Although oral manifestations have been described in prior research, the socio-behavioral profile of responsible caregivers remains insufficiently characterized, particularly in Central and Eastern European contexts. This study aimed to identify caregiver-level socio-behavioral characteristics associated with child dental neglect and to examine their relationships with clinical outcomes. Materials and Methods: A retrospective cross-sectional analytical study was conducted on 333 children (aged 4–17 years) diagnosed with dental neglect, presenting at a municipal hospital and a private dental practice in Oradea, Romania (2020–2024). Caregiver-level variables included age, educational attainment, socioeconomic status, health condition, substance use, and family structure. Associations were analyzed using Fisher’s Exact Test, Pearson Chi-Square, and Mann–Whitney U test, with Bonferroni correction applied where appropriate. Results: Most caregivers were young adults (93.1%), with low educational attainment (40.2% had no formal schooling) and high rates of alcohol use (47.1%). Low family income was present in 89.2% of cases and was significantly associated with non-adherence to the dental treatment plan (p  =  0.039). Caregivers without formal education were associated with neglect in rural areas (43.4% vs. 26.2%; p  <  0.001). Children of drug-using caregivers were significantly older at presentation (median: 12 vs. 8 years; p  =  0.014), and caregiver drug use was more prevalent in urban settings (18.0% vs. 1.8%; p  <  0.001). Over half of the children (52.9%) came from disrupted family environments. Conclusions: Dental neglect was consistently associated with young, poorly educated, and financially disadvantaged caregivers exhibiting high rates of substance use and unstable family structures. These factors may interact in complex ways, highlighting the multifactorial nature of dental neglect. Dental professionals are well positioned for early identification and have a professional and ethical responsibility to integrate child safeguarding into routine clinical practice. Full article

Background/Objectives: The roles of healthy lifestyle and socioeconomic status (SES) in prevalent hypertension, as well as their joint patterns, remain incompletely understood. This study examined the independent, interactive, and joint associations of multidimensional SES and multiple healthy behaviors with prevalent hypertension. Methods: We conducted a cross-sectional analysis of baseline data from 80,218 adults enrolled in the Regional Ethnic Cohort Study in Northwest China between 2017 and 2019. The mean age of the participants was 53.9 years. SES was classified as high, middle, or low according to household per capita income, occupation, and educational attainment. Healthy lifestyle was assessed using five factors: non-smoking, moderate alcohol intake, regular physical activity, adequate coarse-grain intake, and healthy sleep patterns. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations of SES and healthy behaviors with prevalent hypertension. Results: Hypertension prevalence was higher in the low-SES group than in the high-SES group (45.1% vs. 28.8%). Each additional healthy behavior was associated with 16% lower odds of hypertension (OR: 0.84; 95% CI: 0.82–0.86). Within each SES stratum, participants with 0–1 healthy behaviors had the highest odds of hypertension compared with those with 4–5 healthy behaviors (high SES: OR = 1.58, 1.31–1.92; middle SES: OR = 1.62, 1.39–1.89; low SES: OR = 1.58, 1.22–2.05). A similar but weaker pattern was observed among those with 2–3 healthy behaviors (ORs ranging from 1.18 to 1.32). Among participants with 4–5 healthy behaviors, the odds of prevalent hypertension increased as SES decreased (middle SES: OR = 1.06, 95% CI: 0.97–1.16; low SES: OR = 1.29, 95% CI: 1.17–1.42; reference: high SES). This gradient was more pronounced among those with 2–3 healthy behaviors (ORs ranging from 1.24 to 1.55). Conclusions: Both socioeconomic disadvantage and unhealthy lifestyle were associated with higher odds of prevalent hypertension. Although adherence to a healthy lifestyle was associated with lower odds of prevalent hypertension, it did not fully attenuate the excess odds associated with socioeconomic disadvantage. Full article

Due to global change and the associated increase in climate hazards, the study of ecosystem services and their potential to reduce disaster risk has gained relevance in recent years. However, access to ecosystem services is not evenly distributed, leading to environmental injustice. Currently, there is no commonly accepted approach to simultaneously integrate ecosystem services and environmental justice into the risk assessment equation (risk = hazard × exposure × vulnerability). In this study, a framework was developed that integrates ecosystem service assessment into the vulnerability component using InVEST models, which was applied to the case study of Valencia, Spain. The approach applied here not only allowed visualising risk reduction through ecosystem services but also identified a robust synergy between heatwave and flood mitigation as well as mismatches between socioeconomic vulnerability and ecosystem service provision, with foreign residents being at a disadvantage in Valencia. The practical application of this framework in urban planning was shown by comparing the results of the risk assessment of the existing land use conditions with three hypothetical future scenarios. The results support the current municipal ambitions of urban greening in Valencia, while highlighting the need to consider socioeconomic vulnerability in decision-making. Full article

For decades, transportation planning has relied on utilitarian principles, which aim to maximize cumulative benefit by meeting the needs of the “average user.” This approach ignores fundamental differences between population groups and produces uniform solutions that fail to address the diverse needs of women, children, the elderly, and other disadvantaged populations. In response, there are growing calls for a transportation justice paradigm that emphasizes individuals’ ability to access meaningful opportunities according to their characteristics, abilities, and life circumstances. Autonomous Mobility on Demand (AMoD) holds the potential to transform future transportation systems. However, without deliberate planning, they risk replicating existing patterns of inequality for populations whose mobility needs differ from those of the average user. This study applies transportation justice principles to examine how AMoD systems can be designed to meet diverse user needs. Using a combination of an Autoencoder for learning reduced representations and an HDBSCAN clustering algorithm, the analysis identifies distinct travel patterns across socioeconomic groups. These findings reveal significant gaps between population segments, particularly among children and older adults, and demonstrate how AMoD systems could expand access to after-school activities, reduce social isolation among elderly women, and reduce various transportation-related social gaps by improving their ability to reach a wider range of opportunities. Full article

Background: Cardiovascular disease remains the leading global cause of morbidity and mortality. Mental health disorders are common comorbidities that significantly influence how patients access and navigate specialist care. Increasingly, mental illness is recognized not merely as a comorbidity but as a potential driver of inequities in cardiovascular care, affecting diagnosis, referral, procedural management, and long-term secondary prevention. These concerns are particularly relevant in cardiac surgery, where care pathways are complex and resource-intensive. Aims and Objectives: This narrative review examines recent evidence on inequalities in access to cardiac surgery and postoperative outcomes among patients with mental health disorders. Particular emphasis is placed on severe mental illness, mood disorders, anxiety-related conditions, and mixed psychiatric cohorts. Materials and Methods: A structured narrative review approach was employed. PubMed and ScienceDirect were systematically searched for peer-reviewed studies published between 2020 and 2025, including cohort studies, registry analyses, systematic reviews, and meta-analyses. The evidence was synthesized thematically, focusing on access to care, perioperative management, clinical outcomes, underlying mechanisms, ethical considerations, policy implications, and future research directions. Results: Evidence suggests that patients with mental health disorders are more likely to undergo cardiac surgery via emergency pathways, experience longer hospital stays, and have higher rates of readmission. Individuals with severe mental illness are less likely to receive invasive coronary procedures compared to the general population and exhibit higher short- and long-term mortality following acute coronary syndromes. Among psychiatric subgroups, psychosis-spectrum disorders appear to be associated with the greatest excess risk of morbidity, mortality, and adverse long-term surgical outcomes. Conclusions: Patients with mental health disorders face inequities across the entire surgical pathway, including preoperative, perioperative, and postoperative phases. Key contributing factors include stigma, diagnostic overshadowing, fragmented healthcare systems, socioeconomic disadvantage, and insufficiently developed models of integrated care. Addressing these disparities requires redesigned referral pathways, strengthened multidisciplinary collaboration (including cardiology, cardiac surgery, psychiatry, and primary care), and a shift toward interventional research aimed at reducing inequities rather than solely documenting them. Full article

Background/Objectives: Adolescent pregnancy, defined as pregnancy occurring between ages 10 and 19, remains a pressing global health concern with significant disparities in prevalence and outcomes across countries. Early and systematic diagnostic screening may allow timely risk stratification and adequate management. Methods: We conducted this retrospective cohort study at a tertiary referral center from January 2015 through December 2024, including all women who delivered live fetuses at our facility, analyzing adolescent pregnancy outcomes in our region and comparing them with adult pregnancy outcomes. Results: Younger adolescents have higher rates of vaginal infections (45.3% vs. 38.1%), chorioamnionitis, urinary tract infections (6% vs. 4.9%), preterm birth, higher cesarean section rates, SGA and FGR fetuses, with more frequent NICU admissions than older adolescents. Adolescent pregnancies more often resulted in vaginal births compared to adult pregnancies but also showed higher rates of operative vaginal delivery, episiotomy, perineal tears, vaginal tears, and cervical lacerations. Gestational diabetes and excessive gestational weight gain were overall less common in adolescents, but pre-pregnancy maternal obesity was significantly more prevalent in the older adolescent group than in the younger ones. Gestational hypertension was about twice as frequent in adult pregnancies, while HELLP syndrome was approximately six times more common in adults than in adolescents. Conclusions: In summary, adolescent pregnancy presents both potential biological advantages and notable disadvantages, with outcomes resulting from the complex interplay of biological immaturity and socioeconomic factors. These results highlight the critical importance of implementing comprehensive early diagnostic screening protocols and structured antenatal care to facilitate earlier identification and mitigation of modifiable risk factors to improve both maternal and fetal outcomes. Full article

Academically resilient students achieve high performance despite socioeconomic disadvantages. Although this population has received increasing attention, little is known about its motivational heterogeneity, a critical gap given the central role of motivation in persistence and success. Guided by Self-Determination Theory (SDT), this study examined motivational profiles among a population of academically resilient 10th-grade students in Italy (N = 15,751). Using a person-centered approach, Latent Profile Analysis (LPA) identified three profiles: a “multifaceted regulation resilient” profile (72%), marked by low amotivation and high levels across regulations; a “moderately amotivated resilient” profile (21%), with higher amotivation and lower levels of regulation; and a “strongly amotivated resilient” profile (7%), characterized by the highest amotivation and the lowest levels of regulation. Auxiliary analyses indicated that the amotivated profiles, particularly the “strongly amotivated resilient” profile, exhibited higher school dropout intentions than the “multifaceted regulation resilient” profile. Overall, although the majority of academically resilient students displayed multiple coexisting forms of regulation, a non-negligible subgroup showed significant motivational vulnerability, with amotivation emerging as a central risk factor. These findings challenge the assumption that academic resilience is sufficient to protect students from motivational disengagement and dropout risk. High academic achievement, in other words, should not be taken to imply the absence of motivational concerns. This highlights the importance of moving beyond a one-size-fits-all approach, recognizing that even within resilient populations, specific subgroups remain motivationally vulnerable and in need of tailored support. Full article

This study examines how socioeconomic conditions shape learning outcomes in rural schooling contexts through a narrative review of the recent empirical literature. Studies published between 2020 and 2026 were identified through thorough systematic searches of EBSCOhost, Scopus, Web of Science, and Google Scholar. Following screening and eligibility assessment, 50 empirical studies were included in the final synthesis. The review explores how household economic resources, parental education and involvement, and community and institutional conditions interact to influence literacy, numeracy, attendance, grade progression, and educational persistence in rural schools. The findings reveal strong convergence across the literature that structural socioeconomic disadvantage contributes to unequal learning outcomes by limiting access to educational resources, constraining school and institutional capacity, and weakening formal and informal support systems. At the same time, the evidence points to substantial contextual variation and conditionality. The effects of household and parental characteristics are mediated by school quality, governance coherence, and community support structures, while institutional improvements generate uneven outcomes across different rural settings. Building on these patterns, the study develops a multi-level conceptual framework that illustrates how convergence, divergence, and conditionality interact within rural education systems. The review argues that rural educational inequality emerges from the dynamic interaction of socioeconomic and institutional mechanisms rather than from isolated determinants, underscoring the importance of integrated, context-sensitive policy interventions that advance social sustainability objectives. Full article