Search Results (1,255)

How older adults psychologically appraise their health while managing multiple chronic conditions is a behavioral-science question as much as a clinical one. This study estimated the weighted prevalence of favorable mental-health self-appraisal, identified its behavioral, social, and functional correlates, and compared the relative salience of diagnosed-condition burden and functional limitation among U.S. adults aged ≥ 50 years with multimorbidity. This retrospective cross-sectional secondary analysis used the 2023 Medical Expenditure Panel Survey (MEPS) Full Year Consolidated Data File (HC-251). Multimorbidity was defined as at least two diagnosed chronic priority conditions. The primary outcome represents favorable mental-health self-appraisal, derived from MNHLTH53 (excellent/very good/good vs. fair/poor). Covariates were organized using Andersen’s Behavioral Model and health-psychology concepts of adaptation, resources, and lived functional burden. Weighted prevalence estimates and survey-weighted logistic regression models were fitted using PERWT23F, VARSTR, and VARPSU. Robustness checks examined a stricter outcome threshold, proxy adjustment/non-proxy restriction, and a physical-health extension model. The analytic sample included 5523 respondents, representing approximately 77.9 million U.S. adults aged ≥ 50 years with multimorbidity. The weighted prevalence of favorable perceived mental-health self-appraisal was 86.6% (95% CI 85.4–87.7). In the fully adjusted core model (complete-case n = 5330), age 65–74 years (aOR 1.52, 95% CI 1.17–1.98) and age ≥ 75 years (aOR 1.79, 95% CI 1.36–2.36) were associated with higher odds of favorable appraisal. Lower odds were observed for Hispanic respondents, non-Hispanic Asian respondents, lower educational attainment, lower income, non-employment, ≥4 diagnosed conditions, and any functional limitation. The strongest inverse association was limitation status (aOR 0.32, 95% CI 0.27–0.39). Sensitivity analyses were directionally consistent. Favorable mental-health self-appraisal remained common in this medically complex older population, but it was socially and functionally patterned. Functional limitation appeared more behaviorally salient than diagnosis count alone. Because the analysis was cross-sectional and based on household-interview reported measures, these results should be interpreted as associations rather than causal effects. Full article

Urban development in medium-sized provinces is increasingly influenced by the interplay of demographic change, socio-economic disparity, and labour market structure. However, these dimensions are frequently examined in isolation, which limits their utility for integrated regional planning. This study offers a planning-oriented assessment of Amasya Province, Türkiye, by integrating population projections, district-level socio-economic disparity analysis, and labour market indicators to evaluate the province’s developmental trajectory toward 2035. The study utilizes official population data for 2007–2024, district-level socio-economic status scores for 2023, and provincial labour market indicators. Linear trend projection and compound annual growth rate analysis were employed to estimate population change, while the Gini coefficient, Theil index, and coefficient of variation were used to assess intra-provincial socio-economic disparities. Labour market performance was evaluated through participation, employment, unemployment, and employment-to-participation efficiency indicators. The results indicate that Amasya is projected to experience a moderate population increase, reaching approximately 350,118 inhabitants by 2035. Growth is anticipated to remain concentrated primarily in the Central District and Merzifon, while socio-economic advantages also exhibit a central–peripheral pattern. Labour market indicators suggest relatively stable employment performance, although more detailed sectoral, gender, and age-specific analyses are necessary for more robust conclusions. The study contributes an integrated framework for linking demographic projection, socio-economic hierarchy, and labour market capacity in medium-sized provincial planning. The findings suggest that future planning should focus on managing growth in central districts while supporting balanced development in peripheral districts. Full article

Climate change continues to threaten global food security. Climate-smart agriculture (CSA) offers a solution to addressing this challenge in urban agriculture (UA). This paper addresses a gap in the empirical literature on decision-making about the adoption of CSA practices by examining the determinants of CSA adoption among small-scale urban crop (SSUC) farmers in eThekwini (ETH) Municipality, South Africa. Grounded in a utility theory framework, the paper draws on 412 respondents (Cochran-estimated) from a multi-stage sample design across four wards, providing reasonable coverage of SSUC farmers in ETH Municipality. While the sample size is statistically representative of SSUC farmers in ETH Municipality, it is a single metropolitan case rather than universal. The results show strong complementarities among these CSA practices, for example, between OM and CD (r ≈ 0.70, p < 0.001) and M and CD (r ≈ 0.61, p < 0.001). The multivariate probit (MVP) model predicts that the socio-economic and institutional factors age, gender, marital and employment status, education, credit access, extension contact, land tenure, and location (distance from home to farm plots) (p < 0.05) were significant determinants of adopting CSA practices by SSUC farmers. The findings contribute to the global literature on the UA–CSA nexus, demonstrating that socio-economic and institutional factors shape the adoption of bundled CSA practices. While the findings underscore the need for integrated, custom, and UA context-specific policy and extension interventions to strengthen urban food system resilience, UA farmers, practitioners, researchers, and policymakers should apply these insights elsewhere with caution. Full article

Background/Objective: Kinesiophobia is a major fear-avoidance concept in chronic low back pain (CLBP); however, its independent contribution to pain, disability, and health-related quality of life (HRQoL) beyond sociodemographic and clinical variables remains unclear. This study aimed to evaluate the associations between kinesiophobia and patient-reported outcomes in adults with chronic low back pain regarding (i) pain intensity, (ii) functional disability, and (iii) HRQoL. Methods: This cross-sectional study included 298 participants with CLBP (average age 38.7 ± 13.2 years; 58.0% female). Kinesiophobia was evaluated using the Tampa Scale of Kinesiophobia (range, 17–68). Outcomes were pain intensity (Numerical Pain Rating Scale; 0–10), functional disability (Roland–Morris Disability Questionnaire; 0–24), and HRQoL (RAND-36; 0–100). Two multivariable linear regression models were used per outcome. Model 1 was adjusted for sex and age, and Model 2 was additionally adjusted for BMI, marital status, education, employment, smoking status, and chronic disease. Hierarchical regression analysis evaluated the incremental variance explained by kinesiophobia (ΔR²) when entered after all covariates. Effects were reported per 10-point increase in Tampa score, with 95% confidence intervals (CI). Results: In the fully adjusted models, higher kinesiophobia was associated with greater pain intensity (B = +1.17 points per 10 Tampa; 95% CI 0.55–1.79, p < 0.001), greater disability (B = +3.24 points; 95% CI 2.05–4.43; p < 0.001), and lower HRQoL (B = −7.98 points; 95% CI −11.1–−4.81; p < 0.001). Hierarchical regression analyses showed that kinesiophobia explained additional variance in pain (ΔR² = 0.11), disability (0.12), and HRQoL (0.11), all p < 0.001. Conclusions: In adults with CLBP, kinesiophobia was associated with greater pain intensity, functional disability, and lower HRQoL, accounting for 11–12% of variance in each outcome beyond demographic and clinical covariates. These findings support routine assessment of kinesiophobia and justify longitudinal and interventional studies to determine temporal relationships and treatment effects. Full article

Asthma is a chronic respiratory disease with uneven prevalence across population groups. This study investigated the associations between socioeconomic status, health behaviours, and environmental exposures and asthma prevalence across European countries. We conducted a cross-sectional analysis using data from the European Health Interview Survey (EHIS) covering wave III (2019). The sample included 223,453 adults aged 20 or older from 26 European countries. Asthma prevalence was self-reported. Socioeconomic variables included education and employment status, while behavioural factors included smoking and overweight status. Environmental exposures encompassed urbanisation and air pollution. Multilevel logistic regression models examined associations between asthma prevalence and its socioeconomic, behavioural, and environmental factors. Asthma prevalence was higher among individuals with lower educational attainment (OR = 1.30; 95% CI: 1.20–1.40), those who were unable to work due to long-standing health problems (OR = 2.27; 95% CI: 2.04–2.52), and retired individuals (1.44; 95% CI: 1.31–1.57). Individuals with pre-obesity and obesity had increased odds of asthma (OR = 1.13; 95%CI: 1.07–1.19, and OR = 1.76; 95%CI: 1.66–1.86, respectively). Urbanisation (OR = 1.13; 95%CI: 1.07–1.19) and exposure to air pollution (CO₂ and PM_2.5) were both significantly associated with higher asthma prevalence. Six countries exhibited a significant deviation from the average asthma prevalence. Inequalities in asthma prevalence in Europe were linked to socioeconomic disadvantage, unhealthy behaviours, and adverse environmental conditions. Some variability in asthma prevalence was independent of individual characteristics. These findings highlight the need for integrated public health policies that address the structural, behavioural, and environmental determinants of respiratory health. Full article

Purpose: Access to assistive technology (AT) is a fundamental human right and a critical component of Universal Health Coverage (UHC). In the Middle East and North Africa (MENA) region, the scarcity of trained professionals remains a significant barrier to AT service provision. This study evaluates the effectiveness and perceived usefulness of the Assistive Technology Training Program (ATTP), a specialized continuing education initiative designed to build workforce capacity among rehabilitation and healthcare professionals. Methods: A convergent mixed methods design was used to analyze quantitative pre/post-test scores and qualitative focus group open-ended responses. Quantitative data were gathered from 386 participants across 11 MENA countries using a pre- and post-test assessment of AT knowledge. Qualitative utility and participant satisfaction were assessed through a 5-point Likert scale survey evaluating content relevance, trainer expertise, and facilities. Association tests (ANOVA and t-tests) were conducted to identify factors influencing knowledge gain. Results: Participants demonstrated a statistically significant improvement in AT knowledge, with the overall mean score increasing from 3.67 ± 1.13 to 7.50 ± 1.25 (p < 0.001). High levels of satisfaction were reported, with 92% of participants rating the training as “Very Good” or “Excellent” regarding its relevance to clinical needs. Association tests revealed that professional background (p < 0.001), employment status (p = 0.0017), level of education (p = 0.011), and prior training experience (p = 0.026) were significant factors in the magnitude of improvement, although all subgroups achieved significant learning gains. Qualitative thematic analysis per the focus group discussions using the WHO-GATE 5 P framework identified three major themes: (1) Structural Challenges: Issues with Products and Provision point toward a need for better infrastructure and localized supply chains. (2) Human Capital: Personnel barriers emphasize that training shouldn’t just be for professionals, but should extend to caregivers as well. (3) Systemic and Social Change: Policy and People focus on the “soft” side of AT moving toward user-involved guidelines and fighting social stigma to ensure rights are upheld. Conclusions: The ATTP is an impactful educational intervention that significantly enhances the foundational competencies of healthcare professionals in the MENA region. By addressing knowledge gaps and fostering practical skills, the program serves as a preliminary model that demonstrates potential for building regional capacity and supporting the United Nations’ Sustainable Development Goal (SDG) #3 related to health and wellbeing and SDG #4 related to quality education and lifelong learning opportunities for all. Further research is required to evaluate its long-term scalability and clinical impact. Full article

Loneliness and social isolation among older adults pose significant challenges for social sustainability. Intergenerational interaction is a key to promoting social well-being and fostering inclusive communities. Using binary logistic regression and structural equation modeling, this study investigates how neighborhood environments, transportation and recreational walking, and intergenerational interactions, defined as social engagement with children, differ among 871 older adults in intergenerational (n = 436) vs. age-targeted (n = 435) communities in central Texas. Results highlight that accessible “third places”, including streets and sidewalks, churches, and restaurants, were important for supporting intergenerational interactions, with substantially higher levels of such interactions in these places among older adults from intergenerational communities. Employment status moderated the relationship between community types and intergenerational interactions. Across both community types, recreational walking emerged as a significant, positive predictor for intergenerational interactions. Modifiable neighborhood features, particularly the presence of benches along sidewalks, were positively associated with recreational walking, which in turn predicted intergenerational interactions. While age-targeted communities may offer high neighborhood satisfaction and livability, they provide fewer opportunities for routine contact with younger generations. Findings underscore the importance of walkable, inclusive communities and intentional intergenerational programming in promoting intergenerational interaction among older adults, contributing to social sustainability and healthy aging in place. Full article

Background/Objectives: Pharmacists play an essential role in healthcare delivery across Europe, yet growing professional demands, organisational constraints, and evolving practice models may negatively affect job satisfaction and professional fulfilment. This study aimed to evaluate job satisfaction and professional perception among pharmacists across multiple European countries and to identify sociodemographic and workplace-related factors associated with these outcomes. Methods: A cross-sectional, web-based survey was conducted between October 2023 and January 2024 among licensed pharmacists from 17 European countries. Eligible participants were pharmacists employed in community pharmacies, hospitals, clinical pharmacy services, or the pharmaceutical industry. The questionnaire, developed and administered in English, collected sociodemographic and professional data and included two composite measures: the Job Satisfaction Scale (12 items) and the Pharmacist Professional Perception Scale (6 items). Responses were recorded using 5-point Likert scales. Descriptive statistics and inferential analyses were performed using SPSS version 27.0. Results: A total of 789 pharmacists participated (median age 40 years; 80.1% female). The mean job satisfaction score was 3.26 (SD 0.88), with the lowest scores related to staffing adequacy and salary, and the highest to collegial relationships. The mean professional perception score was 3.08 (SD 0.81), indicating moderate perceived professional recognition. Significant associations were identified between both scales and workplace setting, income level, employment status, geographical region, education, and professional experience (p < 0.05). Conclusions: In this multi-country convenience sample, pharmacists reported moderate levels of job satisfaction and professional perception, with variation across workplace and sociodemographic factors. These findings should be interpreted cautiously, as the sample is not representative of all European pharmacists; however, they suggest that staffing conditions, remuneration, professional recognition, and career development opportunities may be relevant areas for further investigation and policy attention. Full article

Background/Objectives: During the first COVID-19 lockdown, the sudden disruption of formal care services substantially increased reliance on informal caregiving. Emerging evidence suggests that increased caregiving demands may have contributed to a higher burden of mental-health-related temporary work disability; however, population-based data from occupational health systems remain limited. This study aimed to quantify and characterise, descriptively, the sociodemographic, clinical, and territorial characteristics of mental-health-related temporary work disability among workers with informal caregiving responsibilities in Spain during the first COVID-19 lockdown, and to descriptively examine differences between episodes occurring among workers with and without caregiving responsibilities. Methods: A retrospective descriptive study was conducted using anonymised nationwide occupational health records from Mutua Asepeyo. All episodes of temporary work disability certified for mental and behavioural disorders (ICD-10 F00–F99) between 14 March and 21 June 2020 were analysed. Caregiver status was determined based on documented informal caregiving responsibilities recorded within the occupational disability records. Sociodemographic, occupational, clinical, and territorial variables were examined using descriptive statistics and non-parametric tests. Results: A total of 2857 caregiver-associated episodes were identified, representing 55.6% (95% CI: 54.2–57.0) of all mental-health-related temporary work disability episodes during the study period. The majority involved women (68.1%) and caregivers of older dependent adults (59.3%). Generalised anxiety disorder was the most frequent diagnosis, followed by adjustment disorders and acute stress reactions, with significant differences by sex and employment regime. Marked territorial variability was observed, as well as longer durations of temporary work disability in specific regions and among women. Conclusions: A substantial proportion of mental-health-related temporary work disability episodes during the lockdown occurred among workers with informal caregiving responsibilities, particularly women and those caring for older dependents. These findings suggest that informal caregiving may be a determinant of occupational mental health during crises. However, given the descriptive and unadjusted nature of the study, no causal inferences can be drawn. Further research is needed to understand these associations better and inform future occupational health strategies. Full article

This study examines the determinants of subjective economic status and life satisfaction among Korean middle-aged individuals, defined as those between 45 and 57 years old. The research explores the impact of eating out expenses, clothing expenses, employment status, and physical exercise on these factors. Data is drawn from the Korean Longitudinal Study of Elderly Employment (KLoEE) for the year 2022, with a sample size of 4392 observations. To test the research hypotheses, quadratic multiple regression analysis was employed. The findings reveal that subjective economic status is significantly influenced by both eating out and clothing expenses, exhibiting an inverted-U-shaped effect. Additionally, an inverted U-shaped relationship between clothing expenses and life satisfaction was also observed. Employment had a positive effect on subjective economic status but a negative impact on life satisfaction. Furthermore, regular physical exercise was found to influence both subjective economic status and life satisfaction positively. The study concludes that subjective economic status positively affects life satisfaction among the Korean middle-aged population. This research contributes to the literature by identifying key behavioral characteristics of this demographic in Korea and discussing relevant policy implications. Full article

Background: Clinical trials are important for advancing medical knowledge and improving healthcare delivery. However, participants’ knowledge and attitudes towards clinical trials remain a key challenge affecting clinical trial recruitment and participant retention. Therefore, this study aimed to assess the knowledge and attitudes of the Bagamoyo district towards participation in clinical trials. Methods: A convergent parallel mixed-methods study was conducted among adults in the Bagamoyo district. Multistage stratified random sampling was used to select participants. Quantitative data were analysed descriptively and using logistic regression, while qualitative data were analysed thematically using NVivo. Results: Among 394 recruited participants, 293 (74.4%) were female and 101 (25.6%) were male. Most participants had a primary-level education (266, 67.5%), while 128 (32.5%) had secondary or tertiary education. The majority were married (297, 75.4%) and 97 (24.6%) were either separated or unmarried. Regarding economic status, 244 participants (61.9%) earned less than TZS 50,000. General knowledge of clinical trials was low, with most participants scoring below 60%. However, we found a positive attitude towards participation in clinical trials. Logistic regression revealed that poor knowledge was significantly associated with being male (AOR, 22.95 (95% CI: 10.27–51.28, p = 0.001)), age above 55 years (AOR of 2.43 (95% CI: 1.29–4.55, p = 0.006)), and unemployment (AOR of 2.39 (95% CI: 1.27–4.53, p = 0.007)). Positive attitudes towards clinical trial participation were significantly associated with being female (AOR) 7.61 (95% CI: 4.32–13.39, p < 0.001), age 44 years and below, (AOR: 2.22 (95% CI: 1.27–3.86, p = 0.005), and employment (AOR of 1.89 (95% CI: 1.08–3.32, p = 0.03). Conclusions: Despite low levels of knowledge, the general population in the Bagamoyo district demonstrated a high willingness to participate in clinical trials. To address the knowledge gap, targeted educational interventions should focus on older adults and the unemployed. Furthermore, policies supporting community outreach and awareness campaigns may help strengthen public understanding and sustain positive attitudes toward clinical research. Full article

Financial inclusion is a key policy priority in developing economies, but significant disparities in access to financial services persist. This study examines the microeconomic drivers of financial inclusion in Morocco using data from the Global Findex 2024, based on a sample of 1014 individuals. A probit model is employed to estimate the probability of holding a financial account, complemented by marginal effects and logit estimations for robustness. The results show that education, employment status, income level, and urban residence significantly increase the probability of financial inclusion, while limited financial literacy reduces it. These findings highlight the persistence of socioeconomic disparities and suggest that financial inclusion in Morocco remains uneven across population groups. By providing updated micro-level evidence, this study contributes to the literature by quantifying the role of key determinants and informing policies aimed at improving financial literacy and reducing territorial inequalities. Full article

This study examines the relationship between sociodemographic factors and total tourist expenditure in the medium-sized UNESCO World Heritage Cities of Úbeda and Baeza, Spain. Using primary data from a structured survey of 1657 visitors, expenditure was analyzed across nine categories. The methodological approach combined descriptive statistics, non-parametric tests, and a Conditional Inference Tree (CTree) model to identify hierarchical segmentation patterns. The analysis revealed seven distinct visitor segments, with nationality as the strongest predictor, followed by employment status, income, and education. Foreign tourists, particularly retired individuals with university degrees, consistently showed higher expenditure levels, especially in accommodation and shopping. Domestic tourists displayed more heterogeneous spending profiles, influenced mainly by income and employment status. Accommodation, food, and shopping dominated expenditure structures across segments, while transport and recreation played a secondary role. By applying an interpretable CTree approach, the study uncovers interaction-based expenditure profiles that are often overlooked in conventional analyses, thereby offering a more nuanced basis for identifying high-spending tourists and informing destination management strategies. Full article

Despite the known benefits of workforce participation, many individuals with disabilities remain excluded. This exploratory study utilises selected analytical tools from constructivist grounded theory to investigate how 46 diverse stakeholders perceive disability during the transition from higher education to employment. Additionally, it examines how these perceptions influence efforts toward inclusion and the advice given regarding disability disclosure. Six workshops were conducted to facilitate dialogue on pathways to work for students with disabilities. The constructivist approach to analysis leads to the development of several concepts that capture stakeholders’ perspectives on disability, their strategies for promoting inclusion, and their recommendations regarding disclosure. Disabilities are conceptualised as an asset, a liability, or as insignificant. The views of disability as an asset or a liability influence advocacy strategies and disclosure recommendations, ranging from celebrating to concealing. These attitudes also shape how individuals who disclose disabilities are perceived. Society often expects people with disabilities to disclose their conditions to promote inclusion, even though performing such can involve risks like stigma and exclusion. At the same time, employers share responsibility for creating inclusive environments through universal design and supportive practices. The findings show that both disclosure and concealment can lead to inclusion or exclusion, emphasising the importance of universally designed institutions. Full article

Background: Performance-based tests (PBTs) objectively assess functional capacity and are increasingly applied in fibromyalgia (FM) to complement patient-reported outcomes (PROMs). However, evidence regarding their reliability, especially considering patients’ socio-occupational status, is limited. This study aimed to determine test–retest reliability of a standardized PBT battery in women with FM and to examine the influence of employment status on measurement stability. Methods: A total of 119 women were assessed (89 with FM). The battery included the 6 min walk test (6MWT), handgrip strength test (HST), and 8 feet up and go test (8FUGT). Test–retest reliability was examined using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and smallest real difference (SRD). Analyses were conducted for the total FM group and socio-occupational subgroups (actively working, claiming disability, and permanent disability). Results: All PBTs demonstrated excellent test–retest reliability. Measurement stability was consistently higher in controls. Absolute reliability indices confirmed acceptable measurement stability. However, the claiming disability group showed markedly higher SEM% and SRD% for HST, suggesting reduced reproducibility. The 6MWT and 8FUGT maintained excellent reliability and stability across all groups. PROMs showed good-to-excellent reliability. Conclusions: PBTs showed excellent reliability in women with FM. However, reliability varied across socio-occupational groups, particularly for HST in patients claiming disability. PROMSs showed lower reliability than PBTs. Full article