Search Results (250)

Historical records and tomb inscriptions have provided foundational insights into the lives of elite women in the Tang Dynasty. However, our understanding of their beliefs—particularly their modes of participation and how they negotiated the tensions between faith and familial responsibilities—remains limited. Most existing scholarship has concentrated on their relationships with parents and children, exploring how they balanced personal spiritual obligations with filial piety and filial duties. In contrast, relatively little attention has been paid to how they managed their relationships with their husbands. This gap in research is partly attributable to the prevailing assumption that women involved in religious ordination were unmarried, either divorced or widowed. This study examines tomb inscriptions of two prominent elite women—Madame Li and Lady Liu—to investigate how they negotiated their faith within the context of their familial and marital relationships. I argue that, owing to their social status, women in the Tang Dynasty, particularly those from the noble and elite classes, engaged in religious activities through a variety of modes that reflect their multifaceted participation in religious life. This broader participation not only challenges conventional perceptions of women’s religious involvement but also reveals the complex ways in which gender, social status, and religious expression intersected during this period. Full article

Objective: To examine the association between the composite dietary antioxidant index (CDAI) and gastric cancer (GC) risk among adults in Southeast China, and to provide evidence for region-specific nutritional interventions. Methods: In this case–control study (July 2023–November 2024), 336 newly diagnosed GC patients were recruited from a hospital in Southeast China, and 336 sex-matched healthy controls were selected from local communities. Dietary data from a validated food frequency questionnaire were used to calculate CDAI scores. Results: A total of 672 participants (56.5% male) were included. The mean CDAI value was 0.47 ± 4.23 in cases versus −0.04 ± 4.61 in controls (p = 0.134), but CDAI quartile distribution differed significantly (p = 0.009). In multivariable analysis of individual CDAI components, vitamin C intake demonstrated a significant inverse association with GC risk, with the strongest protective effect observed in the highest quartile (OR = 0.48, 95% CI: 0.30–0.77, p = 0.002). Selenium intake also showed significant protective effects in the second (OR = 0.52, 95% CI: 0.32–0.83, p = 0.006) and third quartiles (OR = 0.50, 95% CI: 0.30–0.82, p = 0.006). Compared with the lowest quartile, adjusted odds ratios (95% CI) for GC in the second, third, and fourth CDAI quartiles were 0.56 (0.36–0.87), 0.59 (0.38–0.90), and 0.60 (0.39–0.92), respectively. The inverse association was stronger in participants aged >55 years, unmarried, and nonsmokers. Restricted cubic spline analysis revealed a significant nonlinear dose–response relationship. Conclusions: Higher dietary antioxidant intake is associated with lower GC risk. Personalized dietary strategies to enhance antioxidant intake may be particularly beneficial in high-risk populations. Full article

E-commerce platforms are rapidly transforming global consumer behavior, yet the psychological and demographic determinants of sustainable digital consumption remain underexplored. This study investigates how extraversion–introversion personality traits interact with demographic and socio-economic factors to influence e-commerce usage among Korean consumers, with implications for sustainable consumption practices. Based on data from the 13th Korea Media Panel Survey (2022), the results of this study indicate that extraverted individuals, women, younger consumers, higher-educated and higher-income groups, employed and unmarried individuals, those in larger households, and urban residents were more likely to engage in e-commerce, whereas introverts and older adults showed lower participation. These findings highlight the complex interplay between psychological dispositions and structural conditions in shaping digital consumption. This study advances theoretical understandings of the issue by integrating extraversion–introversion traits and demographic variables into a multidimensional framework of consumer behavior. Practically, it emphasizes the need for inclusive e-commerce design: socially interactive features for extraverts, information-rich streamlined interfaces for introverts, and enhanced accessibility for older or rural users. Policy implications include promoting digital literacy, reducing infrastructure inequalities, and implementing ethical, personality-informed personalization strategies to foster equitable and sustainable online commerce. This research contributes to sustainable consumer intelligence by demonstrating how psychological and contextual factors jointly influence e-commerce engagement. Full article

Background: The decline in fertility rates is a growing concern globally, impacting family dynamics and the economy. This study assesses women’s attitudes toward fertility and childbearing in Saudi Arabia and explored their associations with sociodemographic, medical, and psychological factors. Methods: This one-year cross-sectional study involved 2172 Arabic-speaking women aged 18–50 years in Saudi Arabia, with the data collected between December 2022 and January 2023. The online survey, distributed through posts on social media apps as WhatsApp, Twitter, Telegram, Snapchat, and Facebook, measured sociodemographic characteristics, medical and psychiatric history, childbearing preference, and the Arabic version of the Attitudes toward Fertility and Childbearing Scale (AFCS). Results: Item–total correlations ranged from r = 0.124 to higher, all significant at p < 0.01, supporting the scale’s validity. Exploratory Factor Analysis (EFA) identified four emerging factors (eigenvalues > 1), and Bartlett’s test confirmed sample suitability (p < 0.001; Kaiser–Meyer–Olkin = 0.898). Cronbach’s alpha coefficient was 0.898. Participants who were young (71.5%), unmarried (72%), and had psychiatric disorders (16.5%) were more likely to perceive childbearing as less important for their future. Nevertheless, these same groups, along with students (61%), frequently regarded childbearing as a present hindrance that necessitates preparation. Furthermore, participants who were undecided about having children (22.5%) exhibited lower scores in the female identity domain. Conclusions: The Arabic version of the Attitudes toward Fertility and Childbearing Scale appears to be psychometrically sound, encompassing four factors: importance for the future, hindrance at present, childbearing preparation, and female identity. This study found that younger women and those with psychiatric disorders showed lower scores regarding the importance of future childbearing, while college students exhibited more concerns about hindrance and preparation. Full article

Overweight has become a major public health concern in China’s rapidly urbanizing cities. Patterns of environmental exposure differ notably between men and women, both before and after marriage. This study examines how built environment characteristics influence the risk of overweight, with particular attention to nonlinear associations as well as variations by marital status and gender. Drawing on survey data from 2634 Shanghai residents, we applied extreme gradient boosting to model complex environment–health relationships. The results indicate that greenness, park accessibility, population density, and transit conditions are associated with overweight through nonlinear pathways, with threshold and plateau effects suggesting that benefits taper off, or risks escalate, beyond certain levels. These optimal ranges differ across gender–marriage groups: moderate density and green exposure were generally protective, but the effective ranges were narrower for women and unmarried individuals. Married men benefited more consistently, likely supported by healthier routines reinforced through spousal support, whereas married women showed weaker or even adverse effects, potentially due to greater family responsibilities. Overall, the findings reveal that overweight is shaped by socially differentiated nonlinearities in environmental exposures. Urban planning and public health policies should therefore optimize built environment attributes within effective ranges and tailor interventions to diverse demographic groups. Full article

Background and Objectives: Urban–rural health disparities reflect differences in health outcomes, healthcare access, and socio-economic conditions between populations. In Serbia, limited research has quantified how socio-demographic and socio-economic characteristics influence settlement type and healthcare utilization. The aim of this study was to examine the relationship between settlement type and socio-demographic/socio-economic factors, and to assess whether these differences are reflected in patterns of healthcare utilization. Materials and Methods: Data were drawn from the 2019 Serbian National Health Survey, a nationally representative, stratified, two-stage random sample including 12,439 adults aged ≥20 years. Settlement type (urban vs. rural) was the primary dependent variable. Descriptive statistics, Chi-square and t-tests, and bivariate and multivariate logistic regression models were used to assess associations. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, with significance set at p < 0.05. Results: Urban residence was more likely among unmarried individuals, those living in Šumadija/Central Serbia, and those with higher education. Primary or lower education reduced the odds of urban residence, and middle-income groups were less likely to live in urban areas compared to the richest. Settlement type was not significantly associated with hospital or day hospital use. However, rural residents had lower use of prescribed medicines, higher use of non-prescribed medicines, and more frequent physiotherapy visits. Private practice use was over twice as likely in urban settlements. Conclusions: To address urban–rural healthcare disparities in Serbia, targeted strategies could include enhancing health literacy in rural areas, incentivizing physicians to work in underserved regions, expanding telemedicine and mobile health services, improving access to prescribed medications, and strengthening public–private healthcare integration to ensure equitable access across all settlement types. Full article

This study analyzes factors influencing Ukrainian refugee labor market participation in Romania, based on a survey of 399 respondents. The analysis shows that only 21.7% of refugees were employed at the time of the survey. Significant predictors of employment were gender (men had higher employment rates), marital status (unmarried individuals were more active), and Romanian language proficiency, which tripled the chances of finding a job. Education level, English language skills, age, and number of children did not significantly predict employment. The findings also highlight a strong desire among refugees for language learning and professional training, indicating untapped integration potential. This research contributes to the literature on Ukrainian refugee integration by emphasizing the importance of language support policies and gender-sensitive measures. While acknowledging limitations such as convenience sampling and selection bias, our results offer valuable insights for public policy and future research on refugee integration in Europe. Full article

Over the past decades, women’s participation in horticulture has become increasingly apparent across Africa. Women perform physically demanding agricultural work on family farms, as hired laborers, or as paid workers on other farms. To increase yield and protect crops, pesticides are used, yet the health risks faced by these women remain under-researched. This qualitative exploratory case study conducted in 2023, in four villages in northern Tanzania, explored pesticide exposure risks, gender roles, and awareness among women working on horticultural farms. Data were collected through four focus group discussions with 46 women (mean age, 39 years; mean work experience, 10 years). Data was transcribed and thematically analyzed. Six themes emerged: gender division of labor, limited training and awareness, adverse health effects, unsafe storage and disposal practices, inadequate protective measures, and resilience. Although pesticide spraying was typically performed by men, poor or unmarried women also undertook this task. Women had limited access to training on safe pesticide handling, and protective gear was rarely used. Despite awareness of potential health risks, economic necessity and prevailing gender norms compelled continued exposure. Gender-sensitive interventions including targeted occupational health education and promotion of safer agricultural practices are urgently needed to reduce pesticide-related health effects among women. Full article

Background: Meningococcal B (MenB) vaccination offers protection against invasive meningococcal disease and moderate cross-protection against gonorrhea. However, little is known about coverage and behavioral correlates among men who have sex with men (MSM) in China. This study assessed self-reported MenB vaccination uptake and its associations with sociodemographic and behavioral factors. Methods: We conducted a nationwide cross-sectional survey among 1022 MSM recruited via community-based organizations and online platforms. Vaccination status and recent sexual behaviors were self-reported. Logistic regression identified correlates of uptake, and latent class analysis (LCA) examined behavioral profiles. Results: Participants had a mean age of 29.6 years; most were unmarried (87.7%) and nearly 90% had a college degree or above. Overall, 21.7% reported receiving MenB vaccination. Uptake was positively associated with condomless anal intercourse (aOR = 1.57, 95% CI: 1.08–2.31), group sex (occasionally: aOR = 1.63, 95% CI: 1.01–2.64; frequently: aOR = 3.86, 95% CI: 1.85–8.04), and female partners in the past six months (aOR = 3.69, 95% CI: 2.25–6.10). MSM with multiple casual male partners were less likely to be vaccinated (aOR = 0.55, 95% CI: 0.32–0.93). LCA identified heterogeneous subgroups; notably, the “multi-partner and proactive” group, with high pre-exposure prophylaxis against HIV infection awareness and frequent STI testing, showed low uptake (13.4%). Conclusions: MenB vaccination coverage among MSM in China remained suboptimal. Uptake differed across behavioral subgroups, underscoring the need for stratified, context-specific strategies to inform future vaccine introduction. Full article

Vector-borne diseases (VBDs) continue to pose a persistent global health challenge, disproportionately impacting low- and middle-income countries where surveillance and healthcare infrastructure are constrained. Within these countries, residents of remote island communities are particularly vulnerable to emerging VBD threats; however, they remain critically understudied. We conducted a community-based cross-sectional survey of 300 residents from Shahpori Island, Bangladesh, and Gaya Island, Malaysia, to assess knowledge, attitudes, and practices (KAP) related to VBDs. Using a structured questionnaire and mixed-effects Poisson regression modeling, we identified socio-demographic predictors of VBD-related knowledge and compared KAP outcomes across the two islands. Significant disparities were observed between the two settings: the Gaya Island residents demonstrated a higher level of awareness regarding VBDs and preventive practices compared to the Shahpori residents. Education was a strong predictor of VBD knowledge, with individuals possessing secondary education or above exhibiting significantly better knowledge (β = 0.2024, p = 0.0003). Marital status was also a significant factor, with unmarried respondents showing lower levels of knowledge (β = –0.1657, p = 0.0372). Age was positively correlated with VBD knowledge (β = 0.0051, p = 0.0119), indicating a gradual increase with age, while income, gender, occupation, and household size were not significantly associated. Despite basic awareness of VBD symptoms and transmission, detailed understanding of mosquito ecology, disease symptoms, and breeding prevention strategies was remarkably poor, especially among the Shahpori residents. Our findings highlight critical gaps in VBD-related knowledge and prevention behaviors shaped by socio-economic and educational disparities. Community-focused public health strategies including educational campaigns, establishment of health infrastructure, access to trained healthcare providers, and integrated vector control interventions are urgently needed to enhance resilience against emerging VBD threats such as drug-resistant malaria in remote island populations. Full article

Immigrants represent 20.8% of Norway’s population, with 22.2% aged 50+. This study aimed to assess oral health-related behaviors and perceived oral health in relation to sociodemographic factors among elderly immigrants aged 50+. Methods: 174 participants (94% response rate). Data on sociodemographic, oral hygiene, diet, snus use, xerostomia, and halitosis were collected using the self-reported questionnaire. p-value < 0.05 indicates statistical significance. Results: Participants’ mean age was 60.7, with 60% reporting poor self-perceived oral health, and over 64% had missing teeth. Participants reported poor oral hygiene habits (35.1%, n = 61), frequent sugar consumption (51.1%, n = 89), and smoking (16.1%, n = 28). Poor oral health was more common in those aged 60 and over (OR = 2.5, CI: 1.1–5.8) and with a narrow social network (OR = 3.8, CI: 1.7–8.5). Women had lower odds of sugar consumption (OR = 0.38, CI: 0.18–0.8) and smoking (OR = 0.27, CI: 0.09–0.7), but living in Norway for less than 3 years increased smoking odds (OR = 4.5, CI: 1.2–15.8). Moreover, being unmarried (OR = 5.5, p = 0.008), recent immigration (OR = 24.3, p < 001), and a narrow social network (OR = 4.7, p = 0.004) were associated with higher odds of missing teeth. Conclusions: Elderly immigrants in Norway reported poor oral health, tooth loss, and unhealthy dietary and hygiene habits, highlighting the need for targeted interventions. Full article

Adherence to the 6-month tuberculosis (TB) treatment regimen is challenging due to its duration and side effects, with various factors influencing patient compliance. A retrospective cross-sectional study was conducted among newly diagnosed pulmonary TB (pTB) patients in Selangor, Malaysia, undergoing treatment in government primary care clinics and hospitals. Patients who were lost to follow-up (LTFU) within the first six months were determined by reviewing patient records and the national TB registry. Logistic regression analysis identified sociodemographic and clinical factors associated with LTFU. Of the 699 pTB patients, 55 (7.9%) were lost to follow-up. Factors significantly associated with LTFU included age (higher in 25–44-year-olds, adjusted odds ratio (aOR): 2.83), unmarried status (aOR: 2.17), lower education level (aOR: 6.13), being a smoker (aOR: 2.65), and unawareness of TB diagnosis (aOR: 38.14). A significant interaction was found between education level and awareness of diagnosis, with unawareness having a stronger association with LTFU among higher-educated patients. Young adults, those with a lower education level, unmarried individuals, smokers, and those unaware of their TB diagnosis are at higher risk of LTFU. These factors can be used for rapid risk assessment. Intensive counselling and health education at treatment initiation, particularly for at-risk patients, are crucial for preventing LTFU. Full article

Background: Hepatocellular carcinoma (HCC) remains a major cause of cancer-related mortality worldwide, with survival outcomes influenced by a range of demographic and pathological factors. While cirrhosis is a well-established risk factor, recent evidence shows that HCC can also develop in patients with only mild to moderate liver fibrosis. However, there is limited understanding of how fibrosis severity interacts with other clinical variables, such as patient age, to affect mortality. This study aims to explore how fibrosis scores relate to both overall and cancer-specific mortality in US HCC patients, with an emphasis on how this relationship may shift across different age groups. Methods: We utilized data from the Surveillance, Epidemiology, and End Results (SEER) database to identify 15,796 adult patients diagnosed with HCC between 2010 and 2021. Baseline demographics, disease characteristics, and treatment variables were examined. Mortality outcomes were evaluated using Cox proportional hazard regression. Variables significant at p < 0.1 in univariate analysis were included in multivariate models to identify independent predictors of mortality (with hazard ratios [HRs] > 1 signifying increased risk). A secondary analysis assessed how age modifies the association between fibrosis score and mortality. Results: The study population was predominantly male (77.2%), with most patients aged 60–79 (59.6%) and presenting with localized disease (61%). A majority had advanced liver fibrosis or cirrhosis (81.7%) and lived in large urban areas (62.9%). Crude comparisons indicated that male sex, older age, single status, advanced tumor stage, lower income, and cirrhosis were linked to worse outcomes. In adjusted models, independent predictors of increased mortality included male sex, older age, unmarried status, and more advanced disease stage. Receipt of surgery or chemotherapy was associated with a lower risk of death. Notably, the influence of fibrosis on mortality was found to be greater in older patients than in their younger counterparts. Conclusions: This analysis identifies key prognostic indicators in HCC and suggests that the relationship between fibrosis and survival is not uniform across age groups. These findings support the need for age-specific clinical management strategies and highlight the potential benefit of early detection and appropriate interventions, even in non-cirrhotic patients. Full article

Hip fractures in elderly patients pose significant clinical challenges, confronting us with high morbidity and mortality rates. A comprehensive geriatric assessment plays an important role in determining prognosis as well as the indication for surgery. Aim: In this study, we aim to (1) assess frailty-based functional status in seniors with hip fractures, (2) evaluate geriatric assessment’s predictive value for postoperative recovery, and (3) analyze 1-year postoperative survival. Material and Methods: This prospective study included 60 senior patients admitted for hip fracture in the Orthopedics Department. Patients were examined using geriatric assessment instruments Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Mini Nutritional Assessment (MNA), and Frailty Groningen Indicator (GFI). We recorded the sex, marital status, number of comorbidities, and number of recommended drugs. Results: In total, 65% of patients were frail pre-surgery; the proportion increased post-surgery to 86.7%; (p = 0.005). Age greater than 80 years and unmarried marital status were associated with higher frailty risk (p = 0.04; p = 0.03). Preoperatively, important predictors of frailty were mild–moderate cognitive impairment (p = 0.017), mild–moderate depression (p = 0.01), and malnutrition (p = 0.04). Postoperatively, only mild–moderate cognitive impairment (p = 0.04) and mild–moderate depression (p = 0.01) proved to be important predictors of frailty. According to the ROC curve, good predictors of postoperative frailty were shown to be preoperative frailty and the degree of polypharmacy and comorbidity. Of all parameters predictive of postoperative frailty, only the number of medications reached statistical significance (p < 0.038). The study identified a 1-year all-cause mortality rate of 42.6% in elderly patients who underwent hip fracture surgery, with a significant association between mortality and preoperative MMSE, GDS, and MNA scores. Conclusions: Complex geriatric assessment of senior patients with hip fracture can stratify postoperative risk and predict 1-year mortality and postoperative functional recovery. Key predictors include cognitive status, depression, malnutrition, and comorbidities. Multidisciplinary care and standardized evaluation are essential for improving outcomes. Full article

Partner selection is a complex process shaped by structural, social, and personal factors. For refugees and forced migrants, displacement and adaptation add further challenges, with families—even from far away—playing a crucial role in shaping expectations and influencing partnership decisions. This influence can be direct—through arranged marriages or introductions—or indirect, by setting expectations based on ethnicity, religion, or social status. Family endorsement is often crucial in reinforcing ethnic, religious, or language group continuity and community acceptance. This study examines the role of family in partner selection among refugees who arrived in Germany largely during the 2015–2016 period, a group characterized by a high proportion of unmarried men with limited family support. This group is compared to the German resident population, both with and without a migration background. For the descriptive analyses, we draw on two data sources: the PARFORM dataset, collected in 2022–2023, which covers male Syrian and Afghan refugees who arrived between 2014 and 2018; and the ninth wave of the CILS4EU-DE, collected in 2022. The multivariate analyses rely exclusively on the PARFORM dataset and utilize linear probability models with selection correction. We contribute to the literature in three key ways: identifying mechanisms of family influence despite physical distance; introducing a multidimensional framework to measure partnership outcomes based on ethnic, religious, and linguistic endogamy; and providing new insights into the underexplored partnership formation of this refugee cohort. Full article