Search Results (4,628)

Students’ sense of safety at school is an important dimension of school climate and student well-being; however, the factors shaping perceived safety remain insufficiently understood. This study examined the extent to which social, emotional, and contextual factors predict students’ sense of safety at school using data from the OECD PISA 2022 assessment in Lithuania (N = 7257). Structural equation modeling (SEM) was employed to analyze the relationships between students’ sense of safety and school belonging, teacher–student relationships, bullying, school safety risks, stress resistance, life satisfaction, socio-economic status, and gender. The findings suggest that students’ sense of belonging was the strongest predictor of perceived safety. Positive teacher–student relationships, higher life satisfaction, and greater stress resistance were also positively associated with students’ sense of safety, whereas bullying and school safety risks were negatively associated with perceived safety. Socio-economic status and gender demonstrated comparatively weaker effects. Overall, the findings suggest that students’ sense of safety is shaped primarily by relational and psychosocial experiences rather than by background characteristics or the mere absence of risk. The study provides preliminary evidence supporting the importance of fostering inclusive and supportive school environments to strengthen students’ perceived safety. Full article

Background: Objective and subjective socioeconomic status capture distinct aspects of adolescents’ socioeconomic experience, but their joint associations with prosocial moral reasoning and self-acceptance remain unclear. This study examined objective–subjective socioeconomic status configurations in relation to prosocial moral reasoning and self-acceptance, and assessed statistical indirect associations through self-acceptance. Methods: A cross-sectional survey was conducted with 1888 Chinese adolescents aged 12 to 18 years. Participants completed measures of objective socioeconomic status, subjective socioeconomic status, self-acceptance, and prosocial moral reasoning. Polynomial regression and response surface analysis were used, with indirect associations tested using 5000 bootstrap resamples. Results: The full polynomial regression model predicting prosocial moral reasoning was significant, but explained variance was small, and response surface parameters did not indicate significant direct congruence or incongruence effects. Socioeconomic status configurations were more clearly associated with self-acceptance. Self-acceptance was higher when objective and subjective socioeconomic status were both relatively high and when subjective socioeconomic status exceeded objective socioeconomic status. Self-acceptance was positively associated with prosocial moral reasoning, and bootstrap analyses showed significant but very small indirect associations through self-acceptance. Conclusions: Objective–subjective socioeconomic status configurations showed limited direct associations with overall prosocial moral reasoning but clearer associations with self-acceptance. Given the cross-sectional design and small effect sizes, the findings should be interpreted as modest statistical associations rather than evidence of causal mediation. Full article

Background: Long-term fluctuations in body weight may reflect changes in energy balance, illness, or intentional weight loss. However, their association with subsequent triglyceride concentrations remains uncertain. Objective: To examine the association between long-term weight variability and subsequent triglyceride concentrations while accounting for directional weight change. We also assessed the robustness of the findings to adjustment for adiposity, missing data, and socioeconomic and lifestyle covariates. Methods: We analyzed adults from the China Health and Nutrition Survey who had at least three measured weights during 1989–2006 and a triglyceride measurement in 2009. The core complete-case analysis included 5191 participants and adjusted for baseline age, sex, weight slope, number of weight measurements, and working status in 2009. Weight variability was assessed using the coefficient of variation (CV; per 1 SD increment, standardized among 9500 eligible participants) and average successive variability (ASV; per 5 kg increment). Results: In the core model, each 1 SD increment in CV was associated with 2.7% higher triglyceride concentrations (β = 0.026, 95% CI: 0.007 to 0.045; p = 0.007). Each 5 kg increment in ASV was associated with 10.7% higher triglyceride concentrations (β = 0.102, 95% CI: 0.057 to 0.147; p < 0.001). After further adjustment for baseline BMI in the same BMI-complete sample, the corresponding estimates were 3.6% (95% CI: 1.7% to 5.6%) and 5.6% (95% CI: 1.0% to 10.3%), respectively. Multiple imputation yielded similar estimates. A four-knot restricted cubic spline analysis supported an overall association between CV and triglyceride concentrations (p = 0.016), with no strong evidence of nonlinearity (p = 0.101). Marginal standardization yielded adjusted differences in arithmetic mean triglyceride concentrations of 0.048 mmol/L per 1 SD increment in CV and 0.200 mmol/L per 5 kg increment in ASV. Conclusions: Greater long-term weight variability was associated with modestly higher subsequent triglyceride concentrations. Because of the observational design, the heterogeneous causes of weight change, and the possibility of residual confounding, the findings should not be interpreted as causal or independent of obesity. Full article

This study examined the association between physical activity (PA) patterns and physical literacy (PL) among adolescents in Shanghai, China. The researchers conducted a cross-sectional survey between December 2021 and February 2022. They recruited 1624 adolescents aged 11 to 18 from schools in various districts of Shanghai using stratified sampling. Out of these, 1500 provided complete and valid questionnaires for analysis. The researchers assessed PL using a validated adolescent Physical Literacy Questionnaire and measured PA with an updated PA questionnaire that included school-based, household, transportation, and leisure activities. The demographic factors considered included gender, school stage, academic performance, and family socioeconomic status (SES). Two-way multivariate analysis of variance (MANOVA) and multiple linear regression analyses were used to explore group differences and the connections between PA and PL. The MANOVA results showed significant differences in PA based on gender (F(1,1498) = 7.94, p < 0.001) and school stage (F(1,1498) = 9.79, p < 0.001). However, no significant differences were found concerning academic performance (F(1,1498) = 2.12, p = 0.081) or SES (F(1,1498) = 1.90, p = 0.072). On the other hand, PL varied significantly by school stage (F(1,1498) = 9.55, p < 0.001), academic performance (F(1,1498) = 8.84, p < 0.05), and SES (F(1,1498) = 7.94, p < 0.05), but not by gender (F(1,1498) = 1.90, p = 0.121). Furthermore, multiple regression analyses revealed that involvement in school-based, transportation, and leisure-time PA was positively associated with adolescents’ PL, whereas household PA was not. These findings suggest that adolescents’ participation in PA and their PL vary among different demographic groups. Additionally, different PA contexts are associated with varying degrees of PL development. Because of the cross-sectional nature of the study, these findings should be seen as associative rather than indicating a causal relationship. Programs that encourage participation in school-based, transportation, and leisure activities may help improve adolescents’ physical literacy. Full article

Background: Sociodemographic and structural inequities shape the risk of alcohol-related harms among underage individuals. This study assessed disparities in alcohol-related emergency department (ED) visits, using the COVID-19 pandemic as a contextual backdrop to examine how these inequities shifted during a period of widespread disruption. Methods: This repeated cross-sectional study used pooled Nationwide Emergency Department Sample (NEDS) data (January 2019–December 2021) for individuals aged 12–20, comparing pre-COVID-19 (January 2019–March 2020) and during-COVID-19 (April 2020–December 2021) periods. Alcohol-related visits were identified via ICD-10-CM codes. Survey-weighted multivariable logistic regression estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for demographic, socioeconomic, and geographic factors, with interaction terms assessing period-related changes in disparities. Results: Sociodemographic disparities were the primary drivers of alcohol-related ED visits. Native American youth had markedly higher odds than White youth (OR = 3.68, 95% CI: 3.52–3.86), while Black, Hispanic, and Asian youth had lower odds. Uninsured (OR = 1.43) and charity-care youth also showed elevated odds. COVID-19 itself was not significantly associated with overall visits (OR = 1.03, p = 0.053), but disparities widened for Native American youth (OR = 1.20) and narrowed modestly for Black (OR = 1.04) and Medicaid-insured (OR = 1.05) youth, while other disparities remained unchanged. Conclusions: Persistent structural disparities, particularly by race/ethnicity and insurance status, drive underage alcohol-related ED utilization far more than the pandemic itself, underscoring the need for equity-focused prevention strategies targeting systemic barriers to care. Full article

Background: Dementia is a global health priority affecting more than 55 million people worldwide, with projections indicating this figure will rise to 139 million by 2050. People living with dementia (PLWD) face profound difficulties accessing primary care services—the critical gateway to dementia diagnosis, ongoing management, and coordinated specialist referral. Despite growing evidence on individual barriers, a comprehensive synthesis integrating patient, caregiver, and system-level perspectives is lacking. Objectives: This systematic review and meta-synthesis aimed to identify, appraise, and synthesize evidence on the barriers and facilitators experienced by PLWD and their caregivers when accessing primary care services, and to propose evidence-based recommendations to address inequities. Methods: A systematic search was conducted to identify relevant articles in six electronic databases: PubMed, MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Web of Science from January 2000 to December 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Qualitative, quantitative, and mixed-methods studies reporting barriers or facilitators to primary care access for PLWD were included. A convergent integrated synthesis and thematic meta-synthesis approach was applied. Quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Results: Forty-three studies from 18 countries met inclusion criteria. Barriers were categorized across five domains: (1) patient-level factors (stigma, denial, symptom normalization, and limited health literacy); (2) caregiver-level factors (burden, late symptom recognition, and cultural barriers); (3) provider-level factors (insufficient training, therapeutic nihilism, and time constraints); (4) system-level factors (fragmented care pathways, long waiting times, and poor care coordination); and (5) structural and societal factors (rurality, poverty, and ethnic minority status). Facilitators included caregiver advocacy, strong patient–GP relationships, dementia literacy campaigns, availability of memory clinics, and integrated care models. Disparities were consistently greater for ethnic minority groups, rural populations, and those with lower socioeconomic status. Conclusions: Barriers to primary care access in dementia are complex, overlapping, and mutually reinforcing. Effective strategies require multi-level interventions addressing individual, relational, provider, and system dimensions simultaneously. Full article

After the 2021 military coup in Myanmar, many people sought safety, decent work, and social protection in neighboring Thailand. This study examines how legal documentation status and Sense of Place (SOP) are associated with the workplace retention intentions of irregular Myanmar migrant workers in Mae Sot, Thailand. SOP is conceptualized through three key dimensions: emotional bonds to the surrounding environment (place attachment), the extent to which the place meets everyday needs (place dependence), and the way migrants identify with their host context (place identity). To explore these dynamics, we adopted an explanatory sequential mixed-methods approach, surveying 101 respondents between January and April 2024 and subsequently conducting in-depth interviews with 30 individuals between June and July 2024. Given the sensitivity of irregular migration and undocumented legal status, obtaining survey responses was challenging because many potential participants were concerned about privacy, identification, and possible legal exposure. Quantitative data were analyzed using descriptive comparisons, bivariate association tests with Goodman-calibrated minimum Bayes factors, LASSO-assisted variable screening, principal component analysis, and Bayesian mixed-effects ordinal probit models. The descriptive and bivariate results show that legal documentation status is positively associated with all SOP dimensions, job satisfaction, and willingness to remain in the current job. In the candidate model comparison, the Bayesian specification without legal status showed slightly better predictive performance than the corresponding specification with legal status. The primary five-category Bayesian mixed-effects model indicated positive conditional associations of Job Satisfaction, Place Attachment, and the structural workplace index with willingness to stay. It also indicated heterogeneity in the Place Attachment association across observed job tenure groups; this pattern is interpreted as a cross-sectional between-group difference rather than as evidence of individual change over time. Complementary Bayesian sensitivity analyses evaluate the multidimensional SOP construct, the incremental predictive contribution of legal status, sensitivity to alternative priors, and model diagnostics. The qualitative interviews further show that legal documentation is widely perceived as enabling broader employment opportunities, safer access to basic services, employer support, labor rights protection, and reduced exposure to exploitation. Overall, this study highlights the complementary roles of legal recognition, workplace satisfaction, and emotional rootedness in shaping migrant retention, offering implications for decent work, migrant well-being, reduced inequalities, and sustainable labor and migration policies in Thailand’s border regions, particularly in relation to SDG 8 and SDG 10. Full article

Biologic therapies have significantly improved outcomes for patients with moderate-to-severe atopic dermatitis (AD), yet access to these treatments remains uneven and frequently limited. This systematic review synthesizes evidence on insurance-related, financial, administrative, prescriber-level, and structural barriers that limit equitable access to biologic therapies for AD. In contrast to prior reviews that primarily focus on biologic efficacy, safety, or general disease management, this review evaluates access itself as the primary outcome. Across diverse study designs and populations, findings consistently demonstrate that high out-of-pocket costs, restrictive insurance policies, and administrative burdens disproportionately impact low-income, minority, and Medicaid-insured patients. However, racial and ethnic disparities should be interpreted cautiously, as factors like insurance type, Medicaid enrollment, socioeconomic status, geographic access, and other structural determinants may influence these associations. Pediatric patients and caregivers also face challenges such as insurance delays, financial burden, and long-term effects of poor disease control. These barriers contribute to delays in treatment initiation, reduced adherence, and poorer clinical outcomes. Persistent racial, socioeconomic, and geographic disparities further exacerbate inequities in care delivery. Variability in prescribing patterns and provider familiarity with biologics also influence treatment access. Collectively, these findings underscore the need for comprehensive policy reform, streamlined authorization processes, and targeted interventions to improve equitable access to biologic therapies in AD. Full article

Background and Objectives: Aspects of social relationships, like isolation and low social support, have been linked to type 2 diabetes onset, though evidence is inconsistent. We investigated whether social relationships mediate the association between socioeconomic status (SES) and diabetes or interact with SES in relation to diabetes. Materials and Methods: The study included 3642 participants (mean age 58.9 ± 7.6 years, 47.9% male) from the Heinz Nixdorf Recall Study, a population-based cohort in Germany. Baseline examinations took place in 2000–2003 with two 5-year follow-ups. Adjusted relative risks (RRs) were estimated for social relationships (isolation, partnership, instrumental, financial, emotional support) and incident diabetes using Poisson regression with robust variance. We performed causal mediation analyses and estimated relative excess risks due to interaction (RERI). Results: Associations between measures of social integration and diabetes incidence were weak (e.g., RR = 1.09 (95% CI: 0.86, 1.39) for lack of partnership). Limited financial support was associated with higher diabetes risk (RR = 1.33 (1.09, 1.62)), whereas instrumental or emotional support was not. Some evidence of mediation was found for limited financial support (14% (95% CI: −7%, 35%) for the income–diabetes association). There was hardly any excess risk of diabetes in persons with poor education, and poor income, respectively, and low social support (RERI = −0.33 to 0.27). Conclusions: In this prospective study, limited financial support emerged as a social risk factor for type 2 diabetes and explained a small proportion of socioeconomic inequalities in diabetes incidence. Other dimensions of social relationships showed little evidence of independent, mediating, or interaction effects. The findings regarding financial support require confirmation in further studies. Full article

Maternal capital (e.g., anthropometrics, hormones, bioactives) enables investment in infant somatic growth during lactation. We draw from the maternal capital hypothesis to contextualize the associations between human milk cortisol variation and infant height-for-age z-score (HAZ) and weight-for-height z-score (WHZ). We hypothesize stable conditions (e.g., low perceived stress, high socioeconomic status/SES including income and education attained) will be associated with greater milk cortisol declines (i.e., steeper slopes), signaling increased capital to invest in larger infant anthropometrics, while stressful conditions (e.g., illness within the dyad, low SES, poor maternal sleep quality) may be associated with flatter slopes and subsequent reduced investment. We measured milk cortisol (N = 110) in U.S. mother–infant dyads using enzyme immunoassay. We collected milk 30–45 min after waking and at the last evening infant feeding, and provided questionnaires (e.g., demographics, perceived stress, Pittsburgh sleep quality index) for mothers to complete. We calculated milk cortisol slope (%Δ) (AM-PM/AM) to assess variation between collections. Larger %Δ indicated steeper slopes; smaller %Δ indicated flatter slopes. We employed an information-theoretic approach to estimate associations between maternal stress and %Δ, and %Δ and infant anthropometrics using multivariable linear regressions. The %Δ best-fit model suggested maternal postgraduate education and poor sleep quality was associated with steep %Δ. The HAZ best-fit model suggested the combined effect of steeper %Δ and milk intake was associated with increased HAZ. Additionally, the combined effect of steeper %Δ and infant milk intake was associated with increased HAZ among mothers with postgraduate degrees and who woke up three or more times to night-feed. %Δ was not associated with WHZ. We speculate %Δ exposure calibrates infant development to their shared environment, with implications for lifelong fitness. Full article

Growing geopolitical instability has led to increasing concerns about the psychological impact of war beyond directly affected populations, highlighting the need for culturally appropriate instruments to assess fear of war. In this study, we evaluate the psychometric properties of the Turkish version of the Fear of War Scale (FOWARS) and examine its associations with sociodemographic characteristics and personality traits. A total of 643 adults across two independent samples (sample 1 = 360; sample 2 = 283) completed the FOWARS, the Tolerance of Uncontrollability Questionnaire, the Next Big Five Inventory (BFI-2), the Depression Anxiety Stress Scale-21 (DASS-21), and a sociodemographic information form. Confirmatory factor analysis supported the original two-factor structure of the FOWARS, with the Turkish version demonstrating satisfactory structural validity, convergent validity, discriminant validity, criterion-related validity, strong internal consistency, and measurement invariance across gender. Fear of war was negatively associated with tolerance of uncontrollability and positively associated with depression, anxiety, and stress. In addition, fear of war was significantly associated with gender, socioeconomic status, agreeableness, neuroticism, and conscientiousness. These findings expand the understanding of the individual determinants of fear of war, underscoring the importance of developing targeted interventions for vulnerable populations. Full article

Introduction: Multimorbidity, defined as the coexistence of two or more chronic conditions in the same person, represents a major challenge for modern health systems due to its association with adverse health outcomes, increased mortality, and high healthcare utilization. We aimed to assess the prevalence of multimorbidity in the adult population of Serbia and examine its association with demographic and socioeconomic factors and healthcare utilization. Methodology: Data were drawn from the 2019 Serbian National Health Survey. Descriptive statistics, chi-square and independent-samples t-tests, as well as univariate and multivariate logistic regression analyses, were performed to examine the associations. Results: The study included 12,439 adults—48.5% men and 51.5% women (mean age: 52.83 ± 17.69). Multimorbidity was present in 35.2% of participants. It was significantly more frequent among women than men (39.65% vs. 30.53%, p < 0.001) and increased markedly with age, reaching 68.63% among individuals aged ≥80 years. Participants with multimorbidity were significantly older than those without it (p < 0.001). Higher prevalence was observed among widowed individuals, participants with lower education, economically inactive persons, those with poorer material status, and residents of Southern and Eastern Serbia (all p < 0.001). Multivariable regression analysis confirmed independent associations between multimorbidity and female sex, older age, lower education, poorer socioeconomic status, and regional disparities. Multimorbidity was a strong predictor of healthcare utilization. Individuals with multimorbidity were significantly more likely to use inpatient and day hospital services, visit specialist physicians, use prescribed medications, and receive home care (all p < 0.05). Conclusion: Multimorbidity affects more than one-third of adults in Serbia and is strongly associated with demographic and socioeconomic disadvantage. It substantially increases healthcare utilization, underscoring the need for integrated, patient-centered care and targeted public health interventions. Full article

Background: Relapse risks and social reintegration after substance rehabilitation are not only influenced by the individual’s social context, but also by social, family, and socioeconomic circumstances. However, there is limited quantitative research that has studied the co-occurrence of these factors among persons who have been rehabilitated from substance dependence in the Chinese context. Methods: Administrative case narratives from the Legal Services Casebook Database of the Ministry of Justice of China from 2017 to 2021 were analysed. Of the 227 drug rehabilitation-related cases initially identified, 92 contained available and codable information for all variables required for Multiple Correspondence Analysis. Narrative data were coded and then re-categorised into indicators of age, gender, educational level, family relationships, social relationships, financial status, employment status, and recorded relapse history. MCA was not used to estimate the causal effects or prevalence of these categories across the nation, but rather as a method for exploring patterns of association. Results: For the retained complete-case subsample, characteristics of lower educational attainment, unstable employment, financial difficulty, poor family relationships, and poor social relationships tended to be positioned close together in the MCA space. This suggests a pattern of co-occurring psychosocial and socioeconomic disadvantage within the analysed records. Relapse history made a weak contribution to the main MCA dimensions, indicating that recorded relapse alone did not organise the principal structure of association in the data. Conclusions: The findings offer exploratory evidence that reintegration-related disadvantage in these records was configured across relational and socioeconomic domains. Caution should be used when interpreting the results, as they are from a selected, small, complete-case subsample and from variables recoded from administrative narratives. Future research should utilise larger-scale, longitudinal, and mixed-methods datasets to conduct validation studies, to investigate whether these findings are consistent with the remaining data, and to examine their association with long-term reintegration outcomes. Full article

This study examines how school music teachers are represented in English-language television series and considers implications for professional identity, pedagogy and recruitment. Drawing on a novel, systematically coded database of 36 on-screen music educators from 28 television series from 1952 to 2026, quantitative description maps demographic attributes (age, gender, ethnicity, socioeconomic status), narrative role (minor, major, protagonist), genre and institutional context. Our findings show music teachers are most often supporting characters, typically mid-career, male and predominantly white, with comedy—especially ensemble school comedy—dominating portrayals. Qualitative interpretation demonstrates persistent teacher archetypes and pedagogical tropes: the failed performer turned teacher, the inspirational mentor who singles out a talented student, and blurred teacher–student boundaries. These portrayals routinely privilege spectacle and rapid transformation over sequenced curriculum, assessment and routine labour, risking the creation of distorted public expectations about what music teaching entails. This article situates these findings within contemporary concerns about teacher shortages and declining occupational status in English-language contexts, arguing that mediated images may influence career choice, teacher retention and societal attitudes. Methodological advances include expanded time and geographic contexts of studied texts and detailed coding. The paper concludes by calling for reception and experimental studies to test causal effects on aspiring teachers and to inform teacher education curricula. Full article

Non-communicable diseases (NCDs) represent a growing challenge for developing countries, as they are among the leading causes of morbidity and mortality within the working-age population. Beyond their effects on health outcomes, NCDs are associated with reductions in labor productivity, which may influence long-term development dynamics through human capital. This study estimates the conditional labor productivity penalty associated with Non-Communicable Diseases (NCDs) among employed workers in Mexico using an observational high-dimensional framework. By addressing high-dimensional confounding under the Conditional Independence Assumption (CIA), the analysis isolates the relationship between NCD status and hourly labor earnings. Using microdata from the Mexican National Survey of Household Income and Expenditure, labor productivity is defined as the ratio of labor income to hours worked. To obtain robust causal estimates, a Double Machine Learning (DML) framework is implemented, integrating regularized regression and machine learning algorithms to control for high-dimensional confounding factors. These covariates include socioeconomic, demographic, and health-related variables, allowing for flexible adjustment of observable heterogeneity across individuals. The empirical findings demonstrate a statistically significant conditional negative penalty of −11.44% (p = 1.03 × 10⁻¹¹, 95% CI: [−14.59, −8.40]) on hourly labor earnings under the cross-fitted DML specification using XGBoost and Random Forest. To resolve an observational measurement artifact where chronic individuals report artificially inflated hourly wages due to severe hours contraction, a presenteeism adjustment factor ($\theta *=0.8125$) was calibrated. Incorporating this presenteeism correction, the aggregate national economic burden among the employed population is estimated at approximately 496.82 billion pesos annually. The findings suggest that NCDs constitute a relevant constraint on labor productivity at the microeconomic level. The study highlights the importance of prevention-oriented health strategies, workplace health promotion, and early disease management. From a methodological perspective, the results illustrate the usefulness of Double Machine Learning for purging high-dimensional confounding in cross-sectional survey data, providing robust conditional empirical benchmarks for public health policy. Full article