Search Results (3,133)

Major immunization programs and initiatives have prioritized the advancement of equity in immunization. Over the past decade, the World Health Organization has made contributions to understanding inequalities in immunization, including global analyses of immunization inequality as well as tools for knowledge dissemination and capacity strengthening. This article provides an overview of these contributions, highlighting key findings of scholarly reports and journal articles and identifying areas for further research and development to expand monitoring efforts and enhance their impact. Global analyses have primarily drawn from household survey data to explore inequalities related to economic status, education, gender, and geography. Reports and articles address childhood immunization, COVID-19 vaccine indicators, and maternal tetanus protection. Inequalities were reported across all dimensions, with variation by country and income grouping. Time trends generally suggest persistent, though narrowing, inequalities. Areas for further development include the following: increasing awareness and political support for advancing equity in immunization; expanding the collection, availability, and use of disaggregated immunization data; continuous capacity building of inequality monitoring, especially at national and subnational levels; adapting inequality monitoring practices to changing contexts and priorities; strengthening the links between data/evidence and action/impact; and building on existing partnerships and collaborations. Full article

This study examines the key factors influencing the quality of distance learning in higher education during the COVID-19 pandemic, a period when online learning became the dominant mode of education. Using a descriptive method and a 26-item questionnaire, data were collected from a representative sample of 360 students in Vojvodina, Serbia. The factors analyzed include computer literacy and technology access (Ph1), students’ ability to balance life obligations with study demands (Ph2), and their motivation for distance learning (Ph3). The results show that 89% of students had adequate IT access, 47% were able to reconcile study and personal obligations, and 70% reported strong motivation. Correlation analysis confirmed a statistically significant positive relationship between all three factors and students’ perceptions of well-organized distance learning, thus supporting the main research hypothesis. Beyond these findings, this study interprets digital literacy as adaptability, time management as resilience, and motivation as value orientation and future thinking—core dimensions of sustainability competences outlined in the European GreenComp framework. Distance learning is therefore positioned not only as an emergency response but also as a transformative pedagogy that integrates brain (knowledge), hands (skills), heart (values), and spirit (purpose), contributing to sustainable and resilient higher education. Full article

The COVID-19 pandemic caused the world to pause temporarily on an almost planetary scale. The creation and diffusion of knowledge about environmental planning and public health are now almost taken for granted. However, such processes were rather different in pre-pandemic times. It took a substantial dose of labor and resources to generate the information needed to produce useful and usable knowledge, and especially to make it available to others in a timely and effective way. As automobility has come to occupy center stage in the lives of an increasing number of suburbanized dwellers, it has taken multiple energy and public health crises, bold leadership, and the real threat of climate change to create the conditions needed to bolster sustainable Non-Motorized Transportation (NMT) as a complement to cleaner and more convenient mass transit options in cities. How does knowledge about sustainable NMT get created? How are sustainable NMT innovations diffused? How can technological and societal transitions to more sustainable realities be nurtured and augmented? This article utilizes a longitudinal and integrated knowledge creation and diffusion model with a Participatory Planning Process to analyze the adoption of measures aimed at reducing the negative consequences of too much automobility and encouraging higher levels of walking, cycling, and mass transportation. The research methods comprised autoethnographic, qualitative, and policy evaluation techniques. The study makes use of the means and ends matrix to discuss cases from five distinct realms: personal, academic, institutional, volunteering NGO, and private sector. The key findings and lessons learned promote scenarios of managed degrowth and sustainable urban transitions. Full article

Background: This study is particularly relevant to the Romanian context, where relatively few empirical investigations have examined post-pandemic health perceptions and levels of trust in public institutions. The purpose of this study is to investigate the long-term impact of the COVID-19 pandemic on health perceptions and trust in the healthcare system by examining key socioeconomic and epidemiological factors. Methods: A cross-sectional online survey was conducted among Romanian adults (N = 423), between March and April 2025. Demographic data, lifestyle habits, mental health, and access to healthcare were assessed. Statistical analyses included both bivariate (chi-square test) and multivariable logistic regression models to identify independent associations. Results: 31.9% of participants reported increased stress and anxiety during the pandemic. Decreased trust in the healthcare system (75.6%) and a perceived reduction in life expectancy (74.3%) were also noted as a consequence of the COVID-19 pandemic. Perceived life expectancy decline was linked to lower education and inconsistent healthcare behavior. Conclusion: In our sample, the perception of decreased life expectancy reflects not only epidemiological realities but also emotional and social responses to crises. Individuals’ trust, behavior, and shared vision of the future have also been challenged during the COVID-19 pandemic. Full article

Following the significant disruption of traditional teaching by the COVID-19 pandemic, gamified education—an approach integrating technology and cognitive strategies—has gained widespread attention and use among educators and learners. This study explores how game-based learning, supported by situated learning theory and game design elements, can boost learner motivation and knowledge construction. Using 20,293 user comments from the Chinese video platform Bilibili, the study applies sentiment analysis and LDA to uncover users’ sentimental tendencies and cognitive themes. The analysis identifies four core themes: (1) The application of contextual strategies in language learning, (2) Autonomous exploration and active participation in gamified learning, (3) Progressive enhancement of logical thinking in gamified environments, and (4) Teaching innovation in promoting knowledge construction and deepening. Building on these findings, the study further develops a cognitive scaffolding model integrating “contextualization–procedural logic–active construction” to explain the mechanisms of motivation–cognition interaction in gamified learning. Methodologically, this study innovatively combines LDA topic modeling with sentiment analysis, offering a new approach for multidimensional measurement of learner attitudes in gamified education. Theoretically, it extends the application of situated learning theory to digital education, providing systematic support for instructional design and meaning-making. Findings enrich empirical research on gamified learning and offer practical insights for optimizing educational platforms and personalized learning support. Full article

While pregnancy and anticipation of the birth of the first child may be a stressful experience for women, it may also provide an opportunity for personal growth. The literature shows that stress is a prerequisite for growth. However, studies rarely distinguish between different sources of stress. This study therefore sought to increase the theoretical understanding of personal growth by examining the contribution of different stress sources (exposure to pregnancy-related stressors, experiencing pregnancy stress, stress associated with life events during pregnancy, COVID-19-related anxiety over possible economic damage, and COVID-19-related anxiety over the health of the fetus). In addition, drawing on the Broaden and Build Theory, the contribution of dispositional gratitude to personal growth was examined. The sample consisted of 1378 women expecting their first child, who were recruited through social media. Results show that dispositional gratitude has a significant contribution to personal growth (p < 0.001) and that all stress sources except for pregnancy stress, contributed significantly to personal growth (p < 0.05). The study expands the theoretical knowledge and lends support to the need for a theoretical and methodological distinction between different sources of stress. Full article

This research aims to evaluate and highlight the potential mesostructured architecture of established behaviours and operational practices based on the working model change imposed by the pandemic emergency in the public sector. After the intervention of an exogenous shock, the readiness, perceived usefulness and ease-of-use of technologies made the Technology Acceptance Model [TAM] verifiable. Concurrently, it is also possible to verify the Theory of Planned Behaviour [TPB] in the motivation and intention to change employees’ working habits under the lens of complexity and urgency, involving a From Knowledge To Knowledge Strategy [FKTKS]. The research protocol encompasses semi-structured interviews with public managers in Italy, alongside a perceptual and sentiment trend analysis of 70 public employees [35 females and 35 males] regarding their sentiments on digital transition and smart/hybrid working habits before, during, and after the pandemic. In the public sector, change is perceived as a shock-generative tension. In this way, the research aims to answer the genderised issue related to the perception and the persistence of using digital tools in the workplace during the post-urgency period as a regular habit based on perceived usefulness and ease-of-use. The study highlights a gender-specific trend in the use of the smart/hybrid working model after the health emergency. This propensity may also be attributable to the gender traits defined by Hofstede, within whose paradigm the interpretative dynamic provided is embedded. The during-COVID-19 acceptance and usage behaviours define an element related to masculinity because of its urgency and pressing deadlines. In contrast, endurance connects to femininity, emphasising resilience and long-term goals. This approach prioritises resilience and comprehensive well-being, focusing on achieving a good work–life balance [WLB] rather than just addressing immediate issues. Full article

Environmental education plays a vital role in cultivating environmentally responsible citizens. Although teachers are central to environmental education, their pedagogical practices remain under-researched. Thus, this study targeted to systematically review empirical research on environmental education teaching practices to synthesize findings and identify gaps. 2273 papers between 2015 and 2024 from Teacher Reference Center, ERIC, and GreenFILE were filtered to cover studies focused on environmental education teaching practices by teachers under formal education. To interpret trends of discoveries, we propose an expanded Technological Pedagogical Content Knowledge framework—TPAC+E—by incorporating environmental knowledge alongside existing dimensions. Majority of 111 peer-reviewed articles employed case study designs and interviews, with an increasing emphasis on digital technologies in the post-COVID era. Common teaching practices identified include cross-disciplinary integration, outdoor learning, participatory approaches, and the promotion of critical thinking and empathy. However, widespread reliance on textbooks and teacher-centered instruction persists. The review also highlights significant research gaps in primary education and in underrepresented regions such as the Global South and East Asia. We advocate for more interdisciplinary and context-specific approaches, along with enhanced support for teacher training and curriculum development. This review offers both practical and conceptual insights to advance equitable and effective environmental education worldwide. Full article

The recent COVID-19 pandemic outbreak has demonstrated all the limitations of modern healthcare information systems in preventing and controlling pandemics, especially following an unexpected event. Existing approaches often fail to integrate real-time data and adaptive learning mechanisms, leading to inefficient response strategies and resource allocation challenges. To address this gap, in this paper, we propose PROTECTION, an innovative data-centric process-modeling-managing-and-mining framework for pandemic control and prevention that is based on the new paradigm that we name Knowledge-, Decision- and Data-Intensive (KDDI) processes. PROTECTION adopts Business Process Model and Notation (BPMN) as a standardized approach to model and manage complex healthcare workflows, enhancing interoperability and formal process representation. PROTECTION introduces a structured methodology that integrates Big Data Analytics, Process Mining and Adaptive Learning Mechanisms to dynamically update healthcare processes in response to evolving pandemic conditions. The framework enables real-time process optimization, predictive analytics for outbreak detection, and automated decision support for healthcare. Through case studies and experimental validation, we demonstrate how PROTECTION can effectively deal with the complex domain of pandemic control and prevention. Full article

Background: Vaccine hesitancy (VH) remains a pressing global health concern, particularly in low-resource settings, where vaccination remains the primary means of protection against infection. The urgency of this issue became evident during the COVID-19 pandemic. The present study aimed to elucidate the determinants of vaccine hesitancy among university students in medical and non-medical fields in Syria by utilizing the 5C framework (confidence, complacency, constraints, calculation, and collective responsibility). Methods: A structured interview-administered questionnaire collected responses from 4722 students at five universities in Syria. The questionnaire assessed sociodemographic factors, COVID-19 vaccination status, vaccination experience, sources of information, beliefs in vaccine-related conspiracies, attitudes toward vaccine policies and attributes, and the 5C psychological antecedents. Internal consistency and factor analysis of the Arabic 5C scale were performed to ensure construct validity. Statistical analyses included descriptive statistics, logistic regression, and multivariate multiple regression. Results: Our findings revealed that 64% of participants had not received the COVID-19 vaccine, with official sources (e.g., WHO, Ministry of Health) being the most trusted. The highest 5C score was for calculation (5.86, sd = 1.21), followed by confidence (5.29, sd = 1.26). Belief in vaccine conspiracies was common, particularly regarding profit motives and genetic modification. Only three of the 5C—complacency, calculation, and collective responsibility—significantly, predicted vaccination behavior, while all the 5C were influenced by contextual factors. Non-medical students showed significantly higher hesitancy (OR = 1.60, 95% CI [1.39–1.84, p < 0.001]) compared to their medical counterparts. Hesitant respondents displayed significantly, higher complacency, increased calculation, and reduced collective responsibility scores. Conspiracy beliefs eroded confidence and magnified perceived barriers, whereas trust in official sources and favorable views of the vaccine’s attributes strengthened collective responsibility and acceptance. The regression models explained 2.8% to 11.2% of variance across the 5C, with collective responsibility showing the highest explanatory power (adjusted R² = 0.112). Conclusions: Despite high self-reported knowledge, significant VH persisted—a paradox that highlights the limits of information alone. Given the cross-sectional design and the modest explanatory power of the models, these recommendations are tentative. These findings highlight the need for trust-based interventions targeting populations in conflict-affected areas. Full article

For more than 60 years, newborn (or neonatal) screening has flourished through global collaboration, demonstrating that collective action is key to success. This unity proved to be especially vital during the COVID-19 pandemic, when, despite severe disruptions, NBS services were largely preserved, reflecting the high value placed on early detection and care for vulnerable newborns. Today, the International Society for Neonatal Screening (ISNS) recognises that NBS programmes face increasing challenges due to global instability. While direct assistance is not always possible, ISNS emphasises the strength of the international NBS community—scientists, clinicians, patient groups, and industry partners—who are committed to mutual support and knowledge-sharing. Building on the proud legacy inspired by pioneers like Bob Guthrie, this community is enriched by diverse voices and is unified by a shared vision: to ensure that all children with rare disorders have access to life-saving screening and care. Safeguarding and advancing this foundation is a responsibility owed to future generations. Full article

Knowledge gaps exist on whether SARS-CoV-2 co-infection alters recombination frequency or induces phylogenetic incongruities in endemic β-coronaviruses (HCoV-OC43, HCoV-HKU1), limiting our understanding of cross-species evolution. Among 7213 COVID-19 and 1590 non-COVID-19 acute respiratory cases (2021–2022) screened via multiplex PCR, β-coronavirus co-infections (SARS-CoV-2 + HCoV-OC43/HKU1) and single HCoV-OC43/HKU1 infections were identified. Whole-genome sequencing (Illumina NovaSeq) was performed. Phylogenies were reconstructed using Bayesian inference (MrBayes). Recombination was assessed via Bootscan analysis (SimPlot). Co-infection prevalence was low (0.51%, mainly HCoV-HKU1: 0.28%, HCoV-OC43: 0.11%). HCoV-OC43 diverged into lineage 1 (genotype K) and a novel recombinant lineage 2 (genotypes F/J/G/I segments), exhibiting accelerated evolution. HCoV-HKU1 remained genetically stable (genotype B). Co-infection status did not influence evolutionary outcomes. While SARS-CoV-2 co-infection may favor transmission of endemic HCoVs, their evolution appears driven by population-level selection, not co-infection. HCoV-OC43 underwent recombination-driven diversification, contrasting sharply with HCoV-HKU1’s stasis, highlighting distinct evolutionary strategies. Integrated genomic and clinical surveillance is critical for tracking coronavirus adaptation. Full article

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is recognized by pattern recognition receptors (PRRs), which play a vital role in triggering innate immune responses such as the production of type I and III interferons (IFNs). While modest PRR activation helps to defend against SARS-CoV-2, excessive or sustained activation can cause harmful inflammation and contribute to severe Coronavirus Disease 2019 (COVID-19). Altered expression of Toll-like receptors (TLRs), which are among the most important members of the PRR family members, particularly TLRs 2, 3, 4, 7, 8 and 9, has been strongly linked to COVID-19 severity. Furthermore, retinoic acid-inducible gene I (RIG-I) and melanoma differentiation-associated protein 5 (MDA5), collectively known as RLRs (RIG-I-like receptors), act as sensors that detect SARS-CoV-2 RNA. The expression of these receptors, as well as that of different DNA sensors, varies in patients infected with SARS-CoV-2. Changes in PRR expression, particularly that of TLRs, cyclic GMP-AMP synthase (cGAS), and the stimulator of interferon genes (STING), have also been shown to play a role in the development and persistence of long COVID (LC). However, SARS-CoV-2 has evolved strategies to evade PRR recognition and subsequent signaling pathway activation, contributing to the IFN response dysregulation observed in SARS-CoV-2-infected patients. Nevertheless, PRR agonists and antagonists remain promising therapeutic targets for SARS-CoV-2 infection. This review aims to describe the PRRs involved in recognizing SARS-CoV-2, explore their expression during SARS-CoV-2 infection, and examine their role in determining the severity of both COVID-19 and long-term manifestations of the disease. It also describes the strategies developed by SARS-CoV-2 to evade PRR recognition and activation. Moreover, given the considerable interest in modulating PRR activity as a novel immunotherapy approach, this review will provide a description of PRR agonists and antagonists that have been investigated as antiviral strategies against SARS-CoV-2. This review aims to explore the complex interplay between PRRs and SARS-CoV-2 in depth, considering its implications for prognostic biomarkers, targeted therapeutic strategies and the mechanistic understanding of long LC. Additionally, it outlines future perspectives that could help to address knowledge gaps in PRR-mediated responses during SARS-CoV-2 infection. Full article

The global aging population, particularly those aged 60 and above, is increasingly vulnerable to communicable diseases. Building ventilation (BV) plays a key role in residential aged-care (RAC) facilities, where COVID-19 has had a significant impact. This study systematically reviews the published literature to examine the influence of BV systems (BVSs) on airborne disease (COVID-19) transmission in RACs and recommends strategies to protect vulnerable residents. Using the PRISMA framework, articles published in the last decade were sourced from Scopus, Web of Science, and PubMed. Bibliometric analyses revealed key research clusters on risk factors, transmission, facilities and services, and gender-based and retrospective studies. Australia, the USA, Africa, and the UK have made the most scholarly contributions to this field. Three main research areas emerged: BVS functionality, ventilation’s role in COVID-19 transmission, and spatial building design for effective airflow. Findings reveal that inadequate ventilation and poor indoor air quality are major contributors to disease spread, further influenced by ventilation rate, airflow, temperature, humidity, and air distribution. A hybrid ventilation design that integrates natural and mechanical systems with technologies such as HEPA filters, UVGI, and HVAC is recommended in the current study. In addition, building form and layout should incorporate spatial, engineering, administrative, and hierarchical controls in line with sustainable ventilation design guidelines. This study adds to the growing body of knowledge on the roles of ventilation and design in infection control. It offers practical recommendations for architects, RAC managers, government agencies, and policymakers involved in designing and managing RACs to reduce the risk of communicable disease transmission. Full article

Background: Life insurance markets are experiencing unprecedented transformation in the wake of economic disruption, evolving consumer expectations, and behavioral shifts following the COVID-19 pandemic. Traditional economic models often fail to capture the complex interplay of attitudinal, and cognitive factors that now shape insurance demand and premium selection. Methods: This study analyzes nationally representative survey data from over 3600 U.S. adults (2024 NAIC Financial Inclusion Survey). It uses a weighted full maximum likelihood Heckman selection model to identify determinants of life insurance uptake and premiums. The main innovation is modeling psychological price, a composite of perceived affordability, with higher-order polynomials. The design integrates psychometrically validated measures of financial knowledge and risk tolerance. Political ideology, race and ethnicity, and sources of financial advice serve as exclusion restrictions in the selection equation. Results: Psychological price shows an inverse-U relation with term outcomes: uptake rises at low to moderate affordability and declines at high affordability; among purchasers, term premiums rise at low to mid affordability and decline at high levels. For cash value policies, premiums decrease as psychological price increases. Financial knowledge and risk tolerance increase term uptake; financial knowledge reduces cash premiums. Education and income increase term uptake and term premiums. Compared with respondents reporting no ideology, conservative and centrist respondents have lower term uptake and higher cash uptake; using a professional advisor is associated with higher cash uptake. The selection correlation is positive for term ($\rho \approx 0.98$) and negative for cash ($\rho \approx -0.38$), indicating non-random selection in both markets. Implications: In order to reduce disparities, insurers should target the mid-affordability threshold with term offerings, streamline options for high-affordability consumers, offer pricing support and guidance for low-affordability households, increase uptake through advice channels and financial education, and address affordability barriers. Conclusions: Nonlinear affordability effects shape both market entry and pricing choices. Modeling psychological price with higher-order polynomials identifies thresholds and turning points that linear specifications miss. The results support targeted product design and outreach when perceived affordability drives insurance participation and premium choices. Full article