Search Results (2,225)

Introduction: Firefighters are exposed to toxic smoke and hazardous environmental conditions that place them at risk for pulmonary disorders. This study aimed to determine the prevalence of pulmonary symptoms and disorders among full-time firefighters in the City of Cape Town Fire and Rescue Service and to explore associations with sociodemographic, physical and behavioural risk factors. Methods: A cross-sectional, quantitative study was conducted among 278 full-time firefighters using convenience sampling. Data were collected using a researcher-generated questionnaire and spirometry measurements. Physical characteristics were assessed using bioelectrical impedance analysis. Descriptive and inferential statistics were applied (Kruskal–Wallis H, Chi-squared test, Pearson’s correlation), with p < 0.05 denoting statistical significance. Results: More than half (53.60%) of firefighters presented with at least one pulmonary symptom. Coughing (54.36%) and nasal congestion (40.94%) were the most common symptoms. Pulmonary symptoms were more frequent among firefighters aged 30–49 years. Significant differences were found in pulmonary function between age categories (p < 0.01) and obesity in firefighters (p < 0.01). Negative correlations were found between FVC and BMI (r =−0.35), BG% (r = −0.47) and years of experience (r =−0.21). Conclusions: Findings highlight the occupational burden of pulmonary health risks and the need for regular screening and preventive strategies within firefighting populations. Full article

Access to quality seed is a critical driver of smallholder productivity and household food security in South Africa, yet rural communities in the Eastern Cape continue to rely heavily on informal seed systems. Limited seed literacy among farmers and vendors is widely recognized as a constraint to the effective selection and use of high-quality seed. The purpose of this study is to assess seed literacy levels among smallholder farmers in KwaMkhiva village and evaluate how knowledge gaps shape farmers’ seed sourcing patterns and access to quality seed. The study hypothesizes that low seed literacy significantly increases reliance on informal seed systems and reduces adoption of certified or improved varieties. A quantitative, cross-sectional survey design was used to collect data from 50 smallholder farmers and 12 informal seedling vendors, complemented by semi-structured interviews with three extension officers. Descriptive statistics, chi-square tests, correlation analysis, and a composite Seed Literacy Index (SLI) were employed to assess literacy dimensions and their association with seed choices. Findings show that 49% of farmers rely on local markets and 40% use farm-saved seed, with 75% assessing quality visually rather than through germination or varietal indicators. Only 10% had received any seed-related training, and awareness of seed adaptability and crop rotation was below 20%. Higher SLI scores were positively associated with adoption of certified seed (r = 0.42, p < 0.01) and crop diversification. The study concludes that seed literacy is a critical yet underserved capability that shapes smallholder seed access within dual seed economies. Strengthening farmer-centred seed literacy programmes, revitalising extension services, and supporting community seed banks could enhance access to quality seed and improve smallholder resilience. Full article

Background: Medical emergencies in dental practice are uncommon but may have serious consequences if not promptly recognized and managed. Dentists are expected to identify and initiate appropriate interventions during such events; however, the extent to which theoretical knowledge translates into clinical confidence and preparedness remains unclear. Methods: This nationwide cross-sectional survey evaluated dentists’ knowledge, attitudes, and preparedness regarding medical emergencies encountered in routine dental practice. A total of 300 dentists practicing in Türkiye completed two structured questionnaires: a scenario-based single-best-answer multiple-choice questionnaire assessing knowledge of medical emergencies and a Likert-scale questionnaire evaluating attitudes and clinical preparedness. Of the 450 dentists invited to participate, 300 completed the survey (response rate: 66.6%). Overall knowledge scores were calculated from 16 emergency scenarios, and participants were categorized into knowledge-level groups. Associations between knowledge, attitudes, and availability of emergency resources were analyzed using chi-square tests with effect size estimation. Results: The median overall knowledge score was 11 (IQR: 9–13). While high correct response rates were observed for commonly encountered emergencies such as syncope and intraoral bleeding, lower accuracy was noted for high-risk conditions including hypertensive crisis, anaphylaxis, and epileptic seizures. Only 40% of dentists reported feeling sufficiently competent to manage medical emergencies, and avoidance of treating high-risk patients was common. Higher knowledge levels and availability of emergency equipment and medications were significantly associated with greater self-perceived competence and reduced avoidance behavior. Conclusions: Although dentists demonstrate adequate theoretical knowledge of medical emergencies, significant gaps persist in clinical confidence, preparedness, and management of high-risk scenarios. Strengthening emergency preparedness in dental practice requires structured, hands-on training and improved access to essential emergency resources to ensure patient safety and support effective clinical decision-making. Full article

Background: Value-based healthcare (VBHC) has emerged as a promising approach for improving quality while reducing costs. While evidence from tertiary hospitals suggests that outsourcing to VBHC networks can improve safety, efficiency, and satisfaction, less is known about its impact in low- and intermediate-complexity hospitals. The Madrid Regional Health System (RMHS), which stratifies hospitals by complexity, provides a unique opportunity to compare performance across management models. The objective of this study was to compare outcomes between low and intermediate-complexity hospitals outsourced to a VBHC network with those operating under public management and outsourced to traditional for-profit organizations. Methods: The researchers conducted a cross-sectional analysis using the RMHS 2024 annual audit report. Sixteen low- and intermediate-complexity hospitals were included: three outsourced to the VBHC network Quirónsalud and thirteen under public management and outsourced to a traditional private for-profit network. Monographic and long-term facilities were excluded. Variables included case mix complexity, quality and safety indicators (inpatient complications, hospital-acquired infections, low-risk cesarean sections), efficiency metrics (average and case-mix-adjusted length of stay), and patient satisfaction measures (survey scores and patient transfers under the Free Choice of Care Mandate). Continuous variables were compared using Mann–Whitney U tests and categorical variables with Chi-square tests. Results: Study hospitals managed more complex patients (median case-mix 1.06 vs. 0.88, p = 0.007). Despite this, no differences were found in complication rates. Hospital-acquired infections (3.47% vs. 5.46%, p < 0.001) and low-risk cesarean sections (16.1% vs. 19.3%, p < 0.001) were significantly lower in VBHC hospitals. Efficiency was improved, with shorter average length of stay (4.26 vs. 5.03 days, p = 0.031) and all study hospitals demonstrating lower-than-expected case-mix-adjusted stay, unlike several controls. Patient satisfaction was higher (0.91 vs. 0.87, p = 0.007), as were recommendation scores (0.96 vs. 0.92, p = 0.003). Patient transfers favored outsourced hospitals, with more patients choosing them and fewer leaving compared with controls. Conclusions: Low- and intermediate-complexity hospitals managed by a value-based network in Madrid achieved superior performance across safety, efficiency, and satisfaction indicators, despite treating more complex patients. These findings extend evidence for VBHC outsourcing beyond tertiary hospitals, highlighting potential for improved system-wide performance where universal coverage and hospital stratification ensure comparability. VBHC outsourcing may represent a viable strategy to enhance patient outcomes and optimize resource use in regional healthcare systems. Full article

Background: Early cardiopulmonary resuscitation (CPR) and timely use of automated external defibrillators (AEDs) are critical determinants of survival following out-of-hospital cardiac arrest (OHCA). University students enrolled in healthcare degree programs represent a strategic target population for the dissemination of basic life support and defibrillation (BLS-D) skills. However, evidence on their level of knowledge, attitudes, and perceived preparedness remains limited in Southern Italy. Methods: A cross-sectional observational study was conducted between mid-December 2025 and 15 January 2026 among undergraduate healthcare students at the Magna Graecia University of Catanzaro (Italy). Data were collected using a structured, self-administered questionnaire assessing socio-demographic characteristics, CPR/AED knowledge, attitudes, and perceived confidence. Composite knowledge scores were calculated and categorized as poor, sufficient, good, or excellent. Statistical analyses included chi-square tests, Cramér’s V, and Spearman’s rank correlation. Results: A total of 604 students were included (mean age 24.4 ± 6.7 years; 69.9% female), of whom 46.4% reported prior BLS-D training. Knowledge levels were heterogeneous: myocardial infarction was widely recognized as a cause of cardiac arrest (81.1%), whereas recognition of non-shockable rhythms, including asystole and pulseless electrical activity, remained low (<25%). Procedural knowledge, particularly regarding the chain of survival and chest compression rate, improved with academic year and prior BLS-D training. Conversely, ventilation skills and correct AED pad placement were consistently inadequate. Attitudes toward CPR were largely positive; however, perceived confidence in performing resuscitation was moderate to low, especially in complex scenarios. More than 80% of students expressed strong interest in further training and supported mandatory BLS-D education. Conclusions: Healthcare students demonstrated favorable attitudes toward CPR but insufficient and uneven knowledge, particularly in rhythm recognition, ventilation, and AED use. Academic progression and structured BLS-D training were associated with improved competencies, although critical gaps persisted. Integrating mandatory, hands-on BLS-D training with regular refresher sessions into healthcare curricula should enhance preparedness and potentially reduce OHCA-related mortality, especially in high-risk regions such as Calabria. Full article

Viral suppression is a cornerstone of HIV management, essential for improving health outcomes and preventing transmission. However, varying definitions of suppression, ranging from ≤1000 copies/mL (controlled) to ≤200 (clinically suppressed) and ≤50 (untransmittable), complicate the assessment of progress toward global UNAIDS 95–95–95 goals. Our study evaluated progress in achieving viral suppression among people living with HIV (PLHIV) in Tajikistan between 2010 and 2024 using cross-sectional data from the Ministry of Health and Social Protection of Population registry. Viral load was measured using real-time PCR, and suppression was assessed across three thresholds (≤1000, ≤200, ≤50 copies/mL). We examined associations between viral suppression and demographic factors using Chi-square tests and logistic regression models. Across all thresholds, suppression rates remained below the UNAIDS 95-95-95 target goals. At the ≤50 copies/mL threshold, 77% of males and 83% of females achieved suppression, with males demonstrating lower odds of achieving viral suppression. Regional disparities were evident, with Khatlon and Sughd showing the lowest viral suppression rate (72.2% and 76.8%, respectively) and lower odds of achieving viral suppression compared to Dushanbe. Urban–rural differences were also observed (78.3% vs. 81.1%), though odds ratios using logistic regression models were not significant. Findings highlight persistent demographic and regional disparities, underscoring the need for targeted interventions to achieve equitable viral suppression in Tajikistan. Our findings also highlight associations and do not imply causal inference. In addition, authors acknowledge that interpretation of viral suppression outcomes is limited by the absence of data on treatment regimens, duration, adherence, CD4 counts, and behavioral factors. Full article

This paper examines how companies in Slovakia and Poland perceive AI tool utilization and report changes in selected performance indicators after AI adoption (annual turnover, BIT, and employee error rates), and whether these assessments differ across firm demographics (country, company size, and length of operation). Using a CAWI survey of 865 firms and a contingency-table framework with Pearson’s chi-square tests and Cramer’s V effect sizes, we observe statistically significant—yet predominantly weak—associations between firm demographics and both AI utilization and self-reported performance changes. The findings provide actionable implications for managers and policy-support institutions seeking to accelerate AI adoption and value realization in central Europe, while acknowledging the limitations of cross-sectional self-reported data. Full article

Background and Objective: Iron overload remains a significant clinical concern in patients with transfusion-dependent beta-thalassemia (TDT). This study aims to characterize the iron load and endocrine profile of adult transfusion-dependent beta-thalassemia patients and to evaluate their correlation with growth retardation. Methods: A cross-sectional study was conducted at PIMS Hospital, Islamabad, involving 62 adult patients with homozygous or HbE beta-thalassemia receiving regular blood transfusions. Iron overload was assessed using serum ferritin (SF) and transferrin saturation (TS), while endocrine function was evaluated through measurements of thyroid-stimulating hormone-sensitive (TSH), free thyroxine (FT4), and insulin-like growth factor-1 (IGF-1). Data was analyzed using SPSS v26.0 and R v4.3.1, which included Pearson correlation, chi-square testing, and multivariable regression to explore associations between iron indices and endocrine dysfunction. Results: Serum ferritin demonstrated significant negative correlations with FT4 (r = −0.348, p = 0.005) and IGF-1 (r = −0.302, p = 0.015). MRI T2* pancreas values correlated positively with FT4 (r = 0.268, p = 0.037) and IGF-1 (r = 0.312, p = 0.015). Patients with ferritin > 5000 ng/mL exhibited a higher prevalence of low IGF-1 levels (89.2% vs. 64.0%, p = 0.018). No significant gender-based differences were observed in endocrine parameters. Conclusion: Pancreatic iron burden and elevated serum ferritin were significantly associated with impaired thyroid and growth axis function, highlighting the value of integrating MRI T2* and biochemical markers for early endocrine risk stratification in adult TDT patients. Full article

Depression and obesity are a public health crisis in the United States. A plethora of research has established an association between obesity and depression. Research on the relationship between normal weight, non-normal weight (underweight, overweight, and obesity), academic level, and depression among college students is limited. This study aims fills an important gap in the literature by analyzing the association between Body Mass Index (BMI) and depression by academic level. In addition, the interaction between BMI and depression by academic level was also evaluated. Data for this cross-sectional study were collected using a subscale (depression) of the Depression, Anxiety and Stress Scale (DASS-21) from 987 undergraduate and graduate students from two colleges in the Bronx, NY. BMI was calculated using participant’s self-reported height and weight. Data were analyzed using chi-square and logistic regression analyses. Results indicate that students in the normal weight category were less likely to be depressed compared to underweight, overweight, and obese students (Model 1: Adjusted Exp(B) = 0.641, C.I. = 0.416–0.989, and p = 0.044). Those who were in the freshman year were twice as likely to be depressed compared to graduate students (Model 1: Adjusted Exp(B) = 2.236, C.I. = 1.158–4.318, and p = 0.017). A significant interaction between BMI and academic level was found (Model 2: Adjusted Ex(B) = 5.404, C.I. = 1.114–26.221, and p = 0.036). This implies that the association between BMI and depression varies by academic level (sophomore). In conclusion institutions should develop programs that address risk factors for underweight, overweight, obesity, and depression simultaneously, with the goal of improving overall well-being and academic outcomes, especially among lower level (freshmen and sophomore) students. Full article

Background: The use of physical restraints in hospital settings remains a controversial practice due to its ethical, legal, and safety implications. Although restraints are intended to prevent falls or manage agitation, their inappropriate use may compromise patient dignity, autonomy, and quality of care. Current healthcare policies emphasize restraint reduction, appropriate documentation, and professional training as key elements of humanized and safe care. Methods: A descriptive cross-sectional study based on an anonymous self-administered survey was conducted in a tertiary university hospital as the diagnostic phase of a quality improvement project aimed at evaluating healthcare professionals’ knowledge, perceptions, and documentation practices related to physical restraint use. A structured ad hoc questionnaire was distributed to registered nurses and nursing assistants working in adult inpatient units using a non-probabilistic convenience sampling strategy. The survey explored training, clinical decision-making, communication with patients and families, awareness of institutional protocols, and use of the electronic health record (EHR). Descriptive analyses and Pearson’s chi-square tests were performed using IBM SPSS Statistics. Results: A total of 241 professionals participated. More than half of respondents (54.8%) reported no formal training in physical restraint use, and only 27.4% considered their training sufficient. Although 86.3% stated they were familiar with restraint indications, only 53.5% were aware of the existence of a structured EHR restraint registry, and just 31.0% consistently completed it. Documentation of restraint removal was particularly low (32.9%). Furthermore, significant discrepancies were observed between regulatory definitions of restraints and professionals’ perceptions regarding practices requiring formal documentation. Statistically significant associations were identified between professional category, perceived training adequacy, and knowledge of physical restraint indications. Conclusions: This diagnostic phase identified substantial gaps between regulatory requirements, professional knowledge, and real-world documentation practices related to physical restraint use. The findings highlight the need for competency-based training strategies, standardized documentation processes, and strengthened institutional leadership to promote patient safety, regulatory compliance, and the humanization of hospital care. Full article

Homestay tourism is increasingly recognised as a pathway to sustainable tourism development, especially in community-based destinations. This study examines the roles of local community attitudes and environmental sustainability in shaping perceived value and tourist satisfaction within Nigerian homestay tourism. Using a cross-sectional survey design, data were collected from 386 homestay tourists across south-western Nigeria and analysed with Partial Least Squares Structural Equation Modelling (PLS-SEM). The results reveal that local community attitude significantly boosts tourists’ perceived value, while environmental sustainability positively influences both perceived value and tourist satisfaction. However, perceived value does not strongly predict tourist satisfaction, and the moderating effect of community attitude on the relationship between value and satisfaction appears weak. This study contributes to the literature by integrating and extending the Theory of Planned Behaviour (TPB) beyond behavioural intention, demonstrating its relevance to understanding the formation of value–satisfaction in community-based tourism. It also challenges dominant tourism assumptions by showing that perceived value may serve as a supporting rather than primary determinant of satisfaction in rural homestay settings. In practice, the findings suggest that homestay operators and policymakers should focus on environmental sustainability practices and on enhancing experiential service quality, rather than relying solely on value-for-money propositions. By providing context-specific evidence from sub-Saharan Africa, this study advances sustainable tourism scholarship and offers strategic insights for inclusive rural tourism development. Full article

Background: Plant-based milk and dairy alternatives (PBMDAs) are increasingly consumed in Europe, yet evidence from Central Europe remains limited. This study investigated PBMDA consumption habits and perceptions among adults in Slovenia. Methods: A cross-sectional online survey was conducted in June 2024 using a nationally stratified consumer panel (N = 1500). The questionnaire assessed socio-demographics, lifestyle, selected self-reported psychological indicators, dietary pattern, PBMDAs-related beliefs, and interpretation of nutrition and ingredient information. Descriptive statistics and chi-square tests were complemented by multinomial logistic regression and Bayesian analyses. Results: Most participants followed an omnivorous diet, while vegetarians and vegans constituted a minority. Compared with omnivores, vegetarians expressed more favorable perceptions of PBMDAs (health, sustainability, safety), whereas omnivores expressed greater trust in dairy’s nutritional adequacy and stronger concerns about processing and additives. PBMDA perceptions varied by socio-demographics: younger participants and women expressed positive views, and vegetarian/vegan diets were more common among women and higher-educated consumers. Vegetarians/vegans reported more anxiety and body dysmorphic concerns than omnivores. When nutrition information was anonymised, both groups tended to rate dairy as healthier, indicating persistent biases in product evaluation. Conclusions: PBMDA perceptions in Slovenia are strongly segmented by dietary pattern and socio-demographics, supporting the need for clearer nutrition communication. Full article

Background: Oral health (OH) is integral to general health, well-being, and quality of life; however, in long-term care (LTC) settings, it is often neglected due to residents’ functional limitations, high care dependency, and the prioritization of underlying medical conditions by healthcare staff. Previous studies have highlighted this issue and identified multiple barriers to OH promotion in institutional settings. Objectives: To assess OH practices among nurses (NUR) and nursing assistants (NA) in LTC units and to identify barriers compromising effective oral care delivery. Methods: An observational, cross-sectional, descriptive study was conducted across five LTC facilities in Porto, Portugal. A structured survey was administered to 145 healthcare workers out of a total of 259 eligible participants, yielding a response rate of 55.98%. Data were collected via Google Forms and analyzed using IBM SPSS Statistics v.26. Descriptive statistics, analysis of variance, the Mann–Whitney U test, and Chi-square tests were applied, with a significance level of 0.05. Results: The main primary barriers to OH promotion included poor patient cooperation (74.6%), lack of dentists (74.6%), insufficient material (62.7%), limited time (45.8%) and inadequate staffing (40.7%). Chlorhexidine (94.50%) and oral sponges (70%) were the most frequently used resources, whereas other methods were underutilized. No statistically significant differences were observed between professional groups, irrespective of prior training. Although 48.5% of NUR and 51.5% of NA reported not perceiving barriers, substantial gaps in practice were identified. Only 1.9% of untrained NA reported consulting evidence-based scientific sources, compared with 44.7% of untrained NUR. Conclusions: Despite limited perceived barriers, significant deficiencies in OH practices persist in LTC settings, highlighting the need for structured, interdisciplinary training programs to improve oral care delivery. Full article

Electrochemical discharge machining (ECDM) with low machining reaction forces is useful for machining hard and brittle materials, which are required in precision equipment. Lathe-type ECD machines have been proposed to machine axisymmetric shapes while reducing cracks caused by thermal expansion, and they are suitable for thin workpiece machining due to the small reaction force. This paper demonstrates the micromachining of non-circular cross-sections using a lathe-type ECD machine equipped with an improved force-controlled tool electrode holder. The tool electrode holder combining a voice coil motor (VCM) with leaf springs arranged in parallel was built. This holder achieves both flexibility in the longitudinal direction of the tool electrode and high rigidity in the lateral direction. The relationship between the VCM current, tool electrode shift within the tool electrode holder, and thrust force was approximated using a polynomial. Consequently, this device allows for the stable, small contact force required in micromachining. An on-machine shape measurement method was also carried out by combining the tool electrode shift with the motion of an XZ stage. As a demonstration for non-circular cross-section machining, a square cross-section was grooved from a cylindrical glass rod. The removal and measurement processes were alternately repeated to achieve precision. During ECDM, the on/off of the DC power supply for ECDM was synchronized with the rotation of the workpiece. The measurement results indicated some dimensional errors, including bulging at the middle of sides and excessive removal at corners. The bulging was mainly caused by drift due to thermal expansion of the stage, as well as tool electrode wear. Since the tool electrode comes into close proximity to with the machined surface, the discharge from the side surface of the tool electrode caused excessive removal at the corners. Full article

Background: The clinical translation of natural nanomaterials and smart delivery systems in regenerative dentistry relies heavily on practitioner acceptance; however, end-user perspectives remain under-investigated. Objective: This study evaluated dental practitioners’ self-reported knowledge, attitudes, and perceived barriers regarding these innovations. The questionnaire examined stated intention and self-reported willingness, not clinical behaviour. Methods: A cross-sectional survey using convenience sampling was conducted among 713 Romanian dentists. Statistical analysis included Chi-square tests and odds ratio estimation to identify factors associated with willingness to adopt nano-formulations. Results: Self-reported familiarity was moderate, with only 19.1% of respondents describing themselves as “very familiar” with nanodentistry; nevertheless, 77.3% believed natural nano-formulations could match synthetic efficacy. High costs (36.5%), lack of long-term evidence (35.9%), and staining concerns (46.0%) were identified as primary perceived barriers. Experience with digital technologies (CAD/CAM) was significantly associated with a positive attitude toward adoption (OR = 2.05, 95% CI: 1.41–2.98, p < 0.001). Conclusions: Respondents demonstrated a generally positive attitude toward integrating bioactive nanomaterials, though widespread adoption is currently limited by economic, educational, and evidentiary gaps. Future strategies should focus on establishing clear clinical protocols, providing robust long-term safety data, and improving the aesthetic stability of natural biomaterials. Full article