Search Results (293)

Background/Objectives: Recently, the Herpes Zoster (HZ) vaccination has been introduced, alongside influenza and pneumococcal vaccination, at age 65. Factors influencing adherence to this vaccination and its clinical benefits are not completely understood. The aim of this study was to evaluate factors influencing adherence to HZ vaccination compared to pneumococcal and influenza and to assess its clinical effect in preventing acute vascular events. Methods: A total of 1152 patients (520 males), having a birth cohort from 1952 to 1959 inclusive, was recruited, belonging to the District of Udine (N = 839) and to the ASAPs 2 and 3 of Pordenone (N = 313). For each patient, a form was compiled. Results: HZ vaccination was administered to 498 patients, influenza to 665, and pneumococcal to 742 (p < 0.0001). Among the vaccinated, 266 received the live-attenuated version, and 232 the recombinant HZ vaccine. In logistic regression, the presence of addictions, low educational level, and poor socioeconomic status were strongly associated with lower vaccine adherence. The presence of chronic diseases enhanced only pneumococcal (p < 0.001) and influenza (p < 0.001) vaccine adherence. Forty-two non-fatal acute vascular events were recorded from age 65 onwards: 14 cardiac, 20 cerebrovascular, and 8 peripheric. Only 6/493 patients experienced an event following HZ vaccination compared to 36/659 unvaccinated subjects (p = 0.0003). In Cox modeling, HZ vaccination proved to be an independent predictor in preventing subsequent acute vascular events (p < 0.001). Conclusions: The presence of pathologies does not enhance adherence to HZ vaccination while an unfavorable socio-environmental context greatly hinders it. HZ vaccination, but not influenza and pneumococcal vaccination, appears to protect against the occurrence of acute vascular events. Full article

University students worldwide experience considerable health challenges. We examined health inequalities in a nationwide, gender-balanced sample of 1105 German students, considering negative (stress, depression, burnout) and positive health outcomes (self-rated health [SRH], well-being) alongside vertical (subjective social status [SSS], parental academic background) and horizontal (gender) determinants. Analyses used bivariate statistics, multivariate regressions, and interaction terms. Higher SSS was associated with better SRH (β = 0.322) and well-being (β = 0.355), and lower stress (β = −0.154), depression (β = −0.127), and burnout (β = −0.219). First-generation students reported highly significant poorer SRH and well-being than students with one (β = 0.114; β = 0.112) or two academic parents (β = 0.162; β = 0.192). Students with two academic parents showed lower stress (β = −0.087, p = 0.007) and burnout (β = −0.099, p = 0.002). Interactions suggest a protective effect of higher SSS on depression (β = −0.219, p = 0.026) and burnout (β = −0.264, p = 0.006), more pronounced among male students, who additionally benefited more from an academic household regarding SRH (β = 0.100, p = 0.044). These findings underscore intersectional and multifaceted inequalities among German students and the need for interventions. Full article

Background/Objectives: The increasing rate of complex patients with multiple chronic somatic and/or mental disorders in modern medicine is challenging, necessitating special management programs. The aim of the present study was to identify clinical variables and the use of health services associated with the primary-physician-driven inclusion of complex patients in the “Team Management for Complex Patients” (TMCP) special program. Methods: Using validated electronic medical records of a nationwide health maintenance organization, a case–control study was performed. The study compared parameters before enrollment of complex patients included in the TMCP program with those of complex patients during the same time period who were not included, and were matched using a propensity score for age, sex, socioeconomic status, place of residence, ethnicity, smoking status, physical activity, and the balance before the day of enrollment for the major body measurements and laboratory results. Results: The control group was well-balanced, except for the South region and no physical activity. Several respiratory, cardiac, gastrointestinal, neurological, inflammatory and autoimmune diseases were significantly more common among patients included in the TMCP program than among those not included. Complex patients included in the program presented significantly higher previous rates of attending outpatient urgent care centers, visiting hospital emergency departments, hospitalization, and medication use. Conclusions: Although limited by subjective inclusion criteria and potential confounding, the present comparative study identified clinical variables associated with the identification of complex patients for enrollment into a special managed program. These associations may inform future work to develop and validate criteria to support physician decision-making in selecting complex patients for managed programs and designing healthcare resources for patients who need them most. We currently meticulously follow the outcomes of the patients included in the special managed program. Full article

Neuropsychiatric disorders constitute an escalating public health challenge worldwide, with growing evidence suggesting that environmental factors like air pollution may contribute substantially. This prospective cohort study investigated the associations between long-term exposure to fine particulate matter (PM_2.5) and nitrogen oxides (NO_x) and the progression of eight neuropsychiatric disorders among 502,356 UK Biobank participants. Using multi-state models, we analyzed three distinct trajectory stages: stage 1 (transition from baseline healthy status to PHQ-4-positive mood disorders), stage 2 (transition from baseline to ICD-10-diagnosed disorders), and stage 3 (progression from PHQ-4-positive status to clinical diagnosis). Nonlinear exposure–response relationships were subsequently characterized using restricted cubic spline (RCS) regression models. The findings indicated that exposure to both PM_2.5 and NO_x per IQR increase was strongly associated with stage 1, with a corresponding hazard ratio of 1.28 (95% CI: 1.27–1.30) and 1.10 (95% CI: 1.09–1.11). Across the three stages, the risk pattern evolved from being broadly significant to one characterized by disease-specific significance. Alzheimer’s disease was consistently identified as the condition with the strongest association and highest risk linked to air pollution. Specifically, hazard ratios across stages were as follows: 1.08–1.13 in stage 2 and 1.14–1.20 in stage 3 for PM_2.5; and 1.04–1.05 in stage 2 and 1.05–1.10 in stage 3 for NO_x. Subgroup analyses identified heightened vulnerability in females (particularly subjects with depression, Parkinson’s disease, and sleep disorders), younger individuals, and socioeconomically deprived populations. These findings underscore the importance of considering air pollution as a modifiable risk factor in the prevention of neuropsychiatric disorders. Full article

Background: Influenza presents significant risks to older adults; however, vaccination coverage in China remains low despite robust recommendations. Factors such as vaccine hesitancy, physician recommendations, health status, and socioeconomic conditions influence vaccination rates. This study uses large-scale influenza vaccination data from urban older adults in six cities and applies structural equation modeling to investigate the determinants of both influenza vaccination uptake and future intention. Methods: A cross-sectional survey was conducted from December 2024 to January 2025 across six major Chinese cities, involving 13,363 community-dwelling adults aged ≥60 years. Vaccine hesitancy was measured using the validated 5C scale. Structural equation modeling with weighted least squares mean and variance adjusted estimation was employed to assess direct and indirect effects of physician recommendation, socioeconomic status, medical status, and subjective health on influenza vaccination uptake. Results: The vaccination uptake rate is 34.05%, while the intention rate is 32.20%. Vaccine hesitancy is the strongest negative predictor of vaccination (β = −0.488, p < 0.001). Physician recommendation has the largest total effect (β = 0.351), with 45.60% of this effect mediated through reduced vaccine hesitancy. Medical status is directly associated with lower uptake; it consistently promoted intention. Higher socioeconomic status also positively affected vaccination (total effect = 0.167), partly via lower hesitancy. Conclusions: Vaccine hesitancy serves as a pivotal mediator in influenza vaccination uptake and intention among Chinese older adults. Strengthening physician recommendations and addressing socioeconomic disparities are key strategies to reduce hesitancy and improve coverage. Full article

Several studies worldwide have shown that adolescents have low levels of mental health literacy (MHL). This is a worrying situation, given the significant prevalence of mental health disorders among adolescents and the role of MHL in identifying these problems early and seeking help. This study aims to characterize MHL in Portuguese adolescents according to sociodemographic variables. The participants were 608 adolescents from the 7th to 12th grade, who filled in questionnaires on sociodemographics, MHL, and positive MHL. Bivariate analysis and hierarchical logistic regression models were conducted. A high level of adequate beliefs was found to be more likely in girls and in those whose mothers had higher levels of education. High rates of knowledge about self-help strategies were related to older age, having a mother who had a high level of education, greater subjective socioeconomic status (SSES), and better self-perception of mental health (SPMH). Help-seeking/first-aid skills were predicted by higher SSES, and lower SPMH predicted high levels of knowledge about mental health problems. Different MHL dimensions were related to diverse sociodemographic variables, and SPMH played a key role in enhancing the models’ ability to explain variation in MHL—particularly in knowledge on self-help strategies. Those topics require further research. These results can be useful in the development of MHL programs tailored to the specific knowledge needs of different adolescent groups. Full article

Introduction: In recent decades, the burden of mental disorders has become a major determinant of population health in the European Union, generating profound clinical, socioeconomic, and institutional consequences. Despite political recognition of this silent crisis, substantial methodological challenges persist in the transnational monitoring of mental health and in linking disease burden with the resources allocated to address it. The present analysis develops a multivariate taxonomy of EU Member States from a psychosocial perspective, using an integrative quantitative approach. Methods: This cross-sectional, comparative study follows international standards for transparent and reproducible quantitative reporting and is based on 18 harmonized clinical, epidemiological, and institutional indicators collected for 27 EU Member States over the period 2014–2023. The indicators used in this study were grouped according to their position along the care continuum. Hospital-based indicators refer to inpatient activity and institutional capacity, including total hospital discharges, psychiatric admissions (affective disorders, schizophrenia, dementia, alcohol- and drug-related disorders), and hospital bed availability. Outpatient and community-level indicators reflect the capacity of systems to provide non-hospital psychiatric care and consist primarily of psychiatrist density and total specialist medical workforce. Finally, subjective perception indicators capture population-level self-assessed health status, complementing clinical and institutional measures by integrating a psychosocial perspective. After harmonization and standardization, Principal Component Analysis (PCA) with Varimax rotation was applied to identify latent dimensions of mental health. Model adequacy was confirmed using the Kaiser–Meyer–Olkin coefficient (0.747) and Bartlett’s test of sphericity (p < 0.001). Results: Three latent dimensions explaining 77.7% of the total variance were identified: (1) institutionalized psychiatric burden, (2) functional capacity of the health care system, and (3) suicidal vulnerability associated with problematic substance use. Standardized factor scores allowed for the classification of Member States, revealing distinct patterns of psychosocial risk. For example, Germany and France display profiles marked by high levels of institutionalized psychiatric activity, while the Baltic and Southeast European countries exhibit elevated suicidal vulnerability in the context of limited medical resources. These results highlight the deep heterogeneity of psychiatric configurations in Europe and reveal persistent gaps between population needs and institutional response capacity. Conclusions: The analysis provides an empirical foundation for differentiated public policies aimed at prevention, early intervention, and stigma reduction. It also supports the case for institutionalizing a European mental health monitoring system based on harmonized indicators and common assessment standards. Overall, the findings clarify the underlying structure of mental health across the European Union and underscore the need for coherent, evidence-based strategies to reduce inequalities and strengthen system performance at the continental level. Full article

Background: As South Korea transitions into a super-aged society, promoting sport participation among older adults is increasingly vital for physical health, emotional well-being, and social inclusion. Objective: This study examines how the interplay between gender and social stratification influence sport participation and health among South Koreans aged 60 and above. Methods: Using data from the 2024 Korea National Sports Participation Survey (n = 1779), this study employed Multiple Correspondence Analysis (MCA), cross-tabulation, and one-way ANOVA with Scheffé’s post hoc tests to examine differences in sport participation and health by gender and social stratification such as income, education, and occupation. Results: The analysis revealed significant differences in sport participation and subjective health outcomes by gender and social stratification. Among older men, sport participation varied strongly by socioeconomic status: higher-status men participated in golf, cycling, and bodybuilding, whereas those from lower strata mainly engaged in walking and gateball. In contrast, older women’s participation types were less stratified and more influenced by gender norms, with consistent involvement in walking, aerobics, yoga, and stretching. One-way ANOVA showed statistically significant differences (p < 0.001) in subjective health status and physical fitness by all socioeconomic variables for both genders. Conclusions: Older adults’ sport participation and health in South Korea are constrained by both socioeconomic inequality and entrenched gender norms. Promoting equitable active aging requires policies that both reduce socioeconomic barriers and challenge restrictive gender norms. Full article

The relationships among subjective well-being (SWB), active travel, and the built and social environment have been rarely studied, especially in southern cities of Chile. The goal of this research is to investigate the connections between SWB and active travel, along with the associated social, built environment, and individual aspects in Temuco. Furthermore, due to the high levels of socioeconomic segregation (SES) in the city’s various urban neighborhoods, these relationships were studied independently based on two categories of neighborhoods, namely low-SES (NLSES) and high-SES (NHSES), which represent the majority of the city’s areas and population. To ascertain the number of responders in each SES category, a power analysis and simple random sampling were used. Consequently, 481 and 301 respondents were identified for NLSES and NHSES, respectively. A quantitative method and hierarchical multiple regression analysis were used to investigate the goals. The findings indicate that SWB is generally higher in NHSES than in NLSES. It was also found that there was a correlation between subjective well-being and several factors, such as age, some job-related categories, social cohesion, role models, and accessibility to shops, parks, and bus stops. Less SWB is a result of a higher unemployment rate in NLSES as opposed to NHSES. Additionally, a certain lifestyle type in NHSES demonstrated a positive correlation with SWB. Furthermore, there was a positive association found between the NHSES’s SWB and access to the bus network. This study provides evidence from a highly segregated Latin American city that shows how SWB is shaped differently across low- and high-SES neighborhoods. Temuco’s urban policymakers could use these data to improve SWB according to the different types of neighborhoods within this city. Full article

With the accelerating pace of societal digitalization, parental mediation practices have emerged as a critical mechanism for facilitating children’s socialization within the family system. Based on the 2022 Chinese Minors’ Digital Life and Online Protection Survey dataset, this study empirically examined the current state of parental mediation and its influencing mechanism on school-aged children’s academic performance. The results indicated that the level of parental mediation demonstrated a significantly positive influence on students’ academic performance. This finding remained robust when subjected to rigorous validation methods, including instrumental variable analysis, propensity score matching, and double machine learning techniques. Meanwhile, the mediation models showed that children’s e-learning behavior and civic engagement played parallel mediating roles in the relationship between parental mediation and academic performance. Moreover, heterogeneity analysis further revealed that family socioeconomic status negatively moderated the indirect pathways through which parental mediation influenced students’ academic performance. Our research suggested that active parental mediation could not only be beneficial for children’s academic performance but also be helpful to narrowing developmental inequalities across different social classes. Full article

Since the end of Apartheid in 1994, South Africa has striven to address past discrimination against members of marginalized groups such as Africans, women and LGBTQ+ individuals. Sophisticated media legislation and a vibrant civil society forged in the struggle against Apartheid ensure limited discrimination in traditional media and relatively fringe online forums. However, subtle forms of undermining signal the persistent legacy of a colonial and patriarchal past. While incidents of online racism and sexism are relatively well documented, ableism deserves more attention. Despite growing scholarship on digital discrimination, a significant research gap remains in understanding how ableist microaggressions manifest online, particularly when intersecting with race and gender. As a result of established media tropes, microaggressions against people with disabilities are somewhat naturalized and reproduced on social media, yet their intersectional dimensions—especially targeting Black women with disabilities—remain underexplored. This paper addresses this gap through a focused case study of jokes targeting Black women with disabilities in one TikTok video and the approximately 700 comments. Considering (dis)ability’s intersections with race, gender, and socio-economic status, these media texts are subjected to a critical thematic analysis. The study also problematizes the methodological challenges associated with finding, identifying, and purposively selecting such content. The analysis reveals a set of historically and contextually rooted microaggressions expressed through humor, which, as a cultural expression, is inherently covert and thus hard to detect and regulate. This research contributes to understanding how intersectional ableism operates digitally and highlights the need for nuanced approaches to identifying subtle forms of discrimination in online spaces. Full article

This study examines how objective (OSES) and subjective (SSES) socioeconomic status influence adolescent moral reasoning through distinct psychological mechanisms. Analyzing 4122 Chinese adolescents (Mage = 14.38), we found SSES enhanced moral internalization via strengthened social identity, while OSES reduced moral stereotyping through cognitive flexibility. Contrary to expectations, parental emotional warmth failed to buffer against SSES-related declines in internalization, with higher SSES predicting reduced internalization across parenting contexts. Results reveal socioeconomic status operates through dual pathways—social identity processes for SSES and cognitive flexibility for OSES—while challenging assumptions about parenting’s protective role. The findings suggest tailored interventions: identity-building programs for SSES-related moral development and cognitive training for OSES-linked reasoning biases, advancing theoretical understanding of moral development in diverse socioeconomic contexts. Full article

This paper investigates the subjective value perceived by teachers, defined as their overall appreciation of EU-funded educational projects in terms of usefulness, relevance, and impact on education, regarding projects implemented in Romanian schools during the period 2014–2022. The main factors influencing the perceived value were identified through a quantitative approach using a questionnaire-based survey, administered to a sample of 1050 teachers from various regions of the country. The results reveal that improvements achieved in various aspects of the educational environment quality have a positive influence on the analyzed indicator. These improvements can be grouped into two categories of factors that act at the level of school, on the one hand, and at the level of students, on the other hand, both having a significant impact on increasing the perceived value of EU-funded educational projects. The differences between schools that benefited from such educational projects and other schools were also addressed, as well as the influence of the dominant socio-economic status of children studying in different schools on the improvement of the quality of the educational environment. The conclusions highlight the strategic role of European funding in reducing educational disparities and the need to target support to vulnerable schools. The practical and managerial implications include strengthening infrastructure, adapting methodologies, and developing staff competencies, alongside interventions aimed at improving student progress. Full article

Prosocial behavior—children’s capacity to empathize, share, and cooperate—is essential for healthy emotional and social development. While family context plays a critical role in fostering these behaviors, the influence of overall family functioning remains underexplored. This study examines the association between perceived family functioning and prosocial behavior in school-aged children. A cross-sectional design was employed with a sample of 127 parents of children aged 6 to 12 years. Family functioning was assessed using the General Functioning Subscale of the McMaster Family Assessment Device (FAD), and child prosocial behavior was measured via the parent-reported Strengths and Difficulties Questionnaire (SDQ). Analyses included Pearson correlations, linear regression, and group comparisons by gender, education, employment status, and subjective socioeconomic status. Higher family functioning (i.e., lower FAD scores) significantly predicted higher prosocial behavior scores (β = −1.48, R² = 0.12, p < 0.001). A significant difference in prosocial behavior was found between socioeconomic groups, with children from high-income families scoring significantly higher than those from middle-income families. However, family functioning accounted for a greater proportion of the variance than socioeconomic status. These findings underscore the role of family relational quality in shaping children’s social development and highlight its importance in early interventions. Full article

Self-medication is a subject of global importance. If practiced responsibly, self-medication represents a part of self-care or positive care of an individual or a community in promoting their own health. However, today’s practices of self-medication are often inappropriate and irresponsible, and as such appear all over the world. Inappropriate self-medication can be connected with possible serious health risks and consequences. Therefore, it represents a global health issue. It can even generate additional health problems, which will eventually become a burden to healthcare systems and can induce significant costs, which also raises socioeconomic concerns. Hence, self-medication attracts the attention of researchers and practitioners globally in efforts to clarify the current status and define feasible measures that should be implemented to address this issue. This narrative review aims to give an overview of the situation in the field of self-medication globally, including current practices and attitudes, as well as implications for actions needed to improve this problem. A PubMed/MEDLINE search was conducted for articles published in the period from 1995 up to March 2025 using keywords “self-medication” or “selfmedication” alone or in combinations with terms related to specific subthemes related to self-medication, such as COVID-19, antimicrobials, healthcare professionals, and storing habits of medicines at home. Studies were included if self-medication was their main focus. Publications that only mentioned self-medication in different contexts, but not as their main focus, were excluded. Considering the outcomes of research on self-medication in various contexts, increasing awareness of responsible self-medication through education and informing, together with surveillance of particular medicines and populations, could lead to more appropriate and beneficial self-medication in the future. Full article