Menstrual hygiene management (MHM) is a critical yet neglected component of women’s reproductive health in India, particularly among tribal populations who face compounded socio-economic, cultural, and geographic disadvantages. Despite improvements in hygienic menstrual practices at the national level, tribal women continue to lag behind, and evidence on spatial and socio-economic heterogeneity within this group remains limited. This study uses data from the National Family Health Survey-5 (NFHS-5, 2019–21) to examine the prevalence, spatial distribution, and determinants of exclusive hygienic menstrual practices among 44,392 tribal women aged 15–24 years in India. Exclusive hygienic practice was defined as the use of sanitary napkins, locally prepared napkins, tampons, or menstrual cups without concurrent use of unhygienic methods. Descriptive statistics, district-level spatial mapping, and multivariable logistic regression analyses were used to examine the determinants and spatial distribution of exclusive hygienic menstrual practices. Only 65.4
Understanding determinants of quality of life (QoL) in older adults is crucial in aging societies. Intrinsic capacity (IC), combining physical and mental capacities, may be associated with changes in QoL, but evidence on specific IC domains and QoL is limited. The primary objective of this study was to examine the relationship between intrinsic capacity domains and changes in quality of life over a 2-year period among older Europeans, with particular attention to sex and regional differences. Data from 11,493 adults aged ≥ 50 from 13 European countries in SHARE Waves 5 and 6 (2013–2015) were analyzed. IC was operationalized across five domains: mobility, cognition, psychological well-being, sensory function, and vitality. Exploratory factor analysis validated IC’s multidimensional structure. Network analysis assessed domain interrelations and links to QoL (CASP-12). Sex and regional differences were explored via stratified analyses and ANOVA. IC domains formed a coherent multidimensional construct. Psychological well-being and mobility showed relatively stronger associations with QoL than the remaining intrinsic capacity domains. Depressive symptoms and fatigue correlated negatively with CASP-12 (r = − 0.284 and − 0.324, p < 0.001). Cognitive and mobility domains had weaker but significant links. Over 2 years, modest IC declines paralleled QoL changes. Women and individuals in Southern and Eastern Europe exhibited greater IC deficits and lower QoL. Intrinsic capacity was significantly associated with short-term changes in QoL among older Europeans. Psychological and mobility domains are key targets for interventions. Addressing sex and regional disparities in IC may improve well-being and reduce inequalities in aging populations.
As private healthcare plays an increasingly prominent role in Hungary’s dual healthcare system, understanding patient preferences has become essential for health policymakers and healthcare providers. Background data indicate significant underfunding in Hungary’s public healthcare system, leading to long waiting times and limited access—key drivers of private-sector growth. This study investigates attributes associated with stated choice in private healthcare settings using a discrete choice experiment with a quota-representative Hungarian adult survey sample (n = 1,014). A best-worst scaling (BWS) analysis preceded the DCE to identify relevant attributes. The final DCE experimental design included cost, provider distance, appointment availability, provider reputation, and clinic type. The respondents were asked to choose in 8 decision situations, each of which included three private health service options and a no-choice option (to stay in public healthcare). The model estimation was performed using a conditional logit (CL) specification, and willingness-to-pay (WTP) calculations were also conducted. Results revealed that provider distance was the most important attribute (40.01
Mental health challenges are common among individuals with chronic medical conditions, and coping strategies may vary by gender. However, evidence from resource-constrained settings such as Ghana remains limited. This study examined gender differences in mental health outcomes and coping strategies among people with hypertension and diabetes. A cross-sectional study was conducted among 457 patients receiving care at two public hospitals in the Central Region of Ghana. Participants completed self-report measures including the Depression, Anxiety, and Stress Scale (DASS-21) and the Africultural Coping Systems Inventory (ACSI). Data were analysed using descriptive statistics and independent t-tests to assess gender differences. Statistical analysis was done using Jamovi statistical software version 2.5.3. Results showed a high burden of psychological distress among participants. Stress was most common at the severe level, reported by 187 participants (40.9
Physicians’ attire is a visible aspect of clinical care and may influence patients’ trust, confidence, and perceived safety. Evidence from outpatient settings in low- and middle-income countries remains limited. To describe patients’ perceptions of physicians’ attire, grooming and perceived infection risk related to attire and grooming and to identify factors associated with these perceptions. A descriptive cross-sectional study was conducted among adult visitors attending the outpatient department of a tertiary care hospital in Sri Lanka. Consecutive eligible participants were recruited using convenience sampling. A structured self-administered questionnaire assessed perceptions of physicians’ attire, grooming practices, and infection-related risks associated with attire. Associations between participants’ perceptions and sociodemographic characteristics were analysed using Pearson’s chi-square test or Fisher’s exact test, with statistical significance set at p < 0.05. A total of 351 participants were included. Scrubs were the most preferred attire for male [200 (57.0
Measles remains a significant public health challenge in Somalia, contributing to high rates of childhood morbidity and mortality. This study aimed to explore the spatial distribution and identify the individual and community-level determinants of the first dose of measles-containing vaccine (MCV1) uptake among Somali children. Data from the 2020 Somalia Demographic and Health Survey (fieldwork 2018–2019) were analyzed for 3,436 children aged 12–59 months. Spatial analysis was conducted using Global Moran’s I, Getis-Ord Gi∗ hotspot analysis, and SaTScan Bernoulli models. Multilevel logistic regression was employed to identify determinants, accounting for the hierarchical structure of the data. Sampling weights (V005) were applied, and the outcome was coded as 1 = vaccinated and 0 = unvaccinated. The weighted prevalence of MCV1 was 58.3
The Present study has a two-fold objective; firstly, to examine the prevalence of adolescent malnutrition including underweight, stunting, and overweight/obesity and its socio-demographic determinants across Indian states; and secondly, to assess scenario-based future risk prediction of malnutrition among adolescents with particular emphasis on regional disparities across four distinct zones of India classified to understand spatial distribution of malnutrition. We used Comprehensive National Nutrition Survey (CNNS, 2016–18) individual-level data; study analyzed a sample of 35,830 adolescents aged 10–19 years. The burden of adolescent malnutrition was estimated for the entire country by dividing all Indian States in four zones based strictly on the official sampling classifications established by the CNNS framework. Multivariable logistic regression was employed to examine the socio-demographic factors associated with malnutrition including underweight, stunting, and overweight/obesity. Scenario-based zone-wise risk predictions were generated by calculating marginal predicted probabilities from the fitted regression models to estimate how hypothetical changes in key socio-demographic determinants would impact adolescent malnutrition levels across the four distinct zones. The overall prevalence of underweight was highest in zone 4 (30.25
Living a healthy life through eating behaviors is quite challenging given the rapid changes in food consumption patterns in Thai society today. At the same time, the relationship between place and healthy eating can help modify individual eating behaviors, especially in universities where diverse groups of students and working adults come together. Given the limited research on recent eating behaviors in Thai universities, this study aimed to investigate the eating patterns of students and personnel in these institutions. We used secondary data from the university health database, which surveyed eating behaviors in 2025 with 606 participants. Latent Class Analysis (LCA) was employed to identify subgroups of eating behaviors. Four subgroups were identified: unhealthy eaters, passive eaters, conscious eaters, and balanced eaters. Binary logistic regression analysis also revealed interesting outcomes regarding the relationship between factors determining eating behaviors in these four subgroups, including those related to sociodemographic characteristics and health lifestyle. Age showed higher awareness of healthy eating as it increased. Income adequacy remained a significant factor in food choices. Knowledge of food labels, body satisfaction, participation in health-promoting activities, and exercise were key determinants of healthy eating awareness.
Homeless women constitute one of the most vulnerable populations. The aim of the study was to identify the Social Determinants of Health (SDH), also known as social drivers of health among homeless women residing in Iran’s border regions adjacent to Afghanistan, characterized by socioeconomic and healthcare disparities. This qualitative study was carried out between September 2025 and January 2026. The research was conducted in government-operated shelters situated in a low-resource region of eastern Iran. Using Microsoft Office Word 2016, verbatim transcripts of audio-recorded data from 13 semi-structured, in-depth interviews with homeless women, recruited through convenience and purposive sampling, were subjected to a manual thematic analysis following Boyatzis’s methodological approach. The analysis was guided by the Healthy People 2030 framework as the study’s conceptual framework. The thematic analysis revealed 24 SDH under five overarching themes: Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context. The domains of economic stability, along with, social and community context, encompassed the highest number of determinants, presenting their influential role in the ultimate health outcome of homeless women. This study presented a comprehensive list of SDH for homeless women, highlighting the pivotal roles of governments in addressing the issue. The findings hold particular value for low-resource settings.
Criminalisation of sex work has been a problem in the fight against HIV in Nigeria, as it negatively affects the health and economic performance of the people of the country. This commentary presents the argument that decriminalisation is an important and cost-saving measure in controlling the epidemic of HIV in Nigeria. Using the existing epidemiological evidence, the piece illustrates how criminalisation contributes to stigmatisation and forces sex workers into the dark, as well as posing a major obstacle to HIV prevention and treatment interventions and, as a result, beef up infection rates among this vulnerable and critical population. Regarding the health economic approach, the article argues that the existing system squanders limited resources on a punitive system, whereas decriminalisation would facilitate targeted and efficient interventions, including pre-exposure prophylaxis (PrEP) and condom distribution, among others, offering a better return on investment. Ultimately, alternating from criminalisation to a public health-centred approach is not only a social need but also an economic need within the framework of attaining the HIV targets in Nigeria, as well as creating a resilient health system.
Mental health concerns among university students have become a growing priority in higher education, yet limited evidence exists regarding how students perceive the implementation of university mental health policies and support systems. Drawing on the University Mental Health Charter framework and implementation science perspectives, this study examined the relationships among Mental Health Literacy (MHL), Self-Stigma, Enabling Conditions, and three domains of student-perceived mental health policy implementation: Learn, Live, and Support. A cross-sectional survey was conducted with 450 students from eight Vietnamese universities, and the data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). The results indicated that MHL was positively associated with Enabling Conditions (β = 0.412, p < 0.001) and negatively associated with Self-Stigma (β = − 0.419, p < 0.001). Enabling Conditions were positively associated with Learn (β = 0.753, p < 0.001), Live (β = 0.914, p < 0.001), and Support (β = 0.871, p < 0.001). In contrast, Self-Stigma showed a significant negative association only with Support (β = − 0.056, p = 0.024). Mediation analysis revealed significant indirect relationships between MHL and Learn (β = 0.310, p < 0.001), Live (β = 0.376, p < 0.001), and Support (β = 0.359, p < 0.001) through Enabling Conditions. Self-Stigma demonstrated a more limited mediating role, with a significant indirect relationship observed only for Support (β = 0.023, p = 0.035). The model explained substantial variance in Learn (R2 = 0.659), Live (R2 = 0.879), and Support (R2 = 0.806). Overall, the findings indicate that student-perceived implementation was statistically associated with both Mental Health Literacy and perceived institutional conditions, with Enabling Conditions showing the more prominent specific indirect associations. These findings identify institutional enabling conditions as a relevant area for further longitudinal research and institutional evaluation within a whole-university approach to student mental health.
This study examines the effectiveness of e-health services in improving healthcare delivery at the Upazila Health Complex (UHC) level in Bangladesh. A mixed-method research design was employed in this study. Quantitative data were collected from 384 respondents selected through simple random sampling to measure awareness, readiness, perceived benefits, and perceived barriers of e-health services. Qualitative data were generated through purposive face-to-face interviews with 16 service recipients and 10 service providers to gain in-depth insights into existing practices and challenges at UHCs. Although 81.0
The aim of the current study is to investigate how wives operate as leaders in alcohol-affected households in Kerala’s Alappad coastal region. A multi-method, qualitative research methodology was used. Twenty married women from households impacted by alcoholism in Kerala’s Alappad coastal region participated in the research. The data saturation method was used to choose participants for in-depth interviews, whereas convenience sampling was used to choose participants for the Focus Group Discussion (FGD). Semi-structured interview guides and FGD questions about marital relationships, family roles, decision-making, emotional experiences, and coping mechanisms were used to gather data. Thematic analysis was used to examine the gathered data in accordance with Naeem’s methodology. The results showed that spouses’ alcoholism significantly disrupted conventional family roles. The in-depth interviews revealed several themes, such as the disruption of family roles brought on by alcohol addiction, the shift into functional leadership, managing societal expectations and gender norms, coping, adaptation and resilience, and rethinking authority and family structure. The breakdown of traditional male family roles, normalization of women’s functional leadership, negotiation of gender norms and social judgment, shared emotional burden and collective coping, collective resilience and empowerment were the topics that emerged from the focus group discussion. The study emphasizes how gender roles and family structures are altered in alcohol-affected families. The results highlight the need for psychological support, family-centred therapies, and more acknowledgement of women’s resilience and leadership in families affected by alcohol.
Healthcare workers (HCWs) are the cornerstone of pandemic response, yet their subjective well-being may be compromised by unavoidable occupational risks. While current research has documented the immediate psychological impact of COVID-19, fewer studies have tracked how self-reported happiness among HCWs changes as public health policies shift from emergency measures to their subsequent lifting. This study examines the dynamics of self-reported happiness among HCWs compared to other workers in Japan, focusing on the transition from the COVID-19 state of emergency to the period after the emergency was lifted. We constructed unique individual-level panel data through internet surveys conducted five times between March 13 and June 12, 2020. The analytic worker sample contains 10,901 person-wave observations for the panel models, and 10,689 observations for the OLS, Ordered Logit, FE OLS and Probit analyses. Happiness was self-reported on an 11-point scale ranging from 0 (least happy) to 10 (most happy). To address concerns regarding the ordinal nature of the happiness outcome, we estimated OLS, Ordered Logit, Probit, and Panel Ordered Logit specifications and compared their findings. The key findings are as follows: (1) Overall, the happiness level of HCWs was consistently lower than that of other workers. (2) The largest disparity in happiness levels between HCWs and other workers was observed after the state of emergency was lifted. In the fixed-effects specification, the Wave 5 × Healthcare Worker coefficient indicates that the healthcare worker-other worker gap widened by 0.26 points on the 11-point scale relative to Wave 1. These findings are consistent across linear (OLS, FE OLS), ordinal (Ordered Logit and Panel Ordered Logit), and binary (Probit) specifications. The Probit estimate shows that healthcare workers were 13.8
The COVID-19 pandemic has accelerated the adoption of digital health technologies worldwide, positioning them as pivotal tools in the pursuit of universal health coverage (UHC). This commentary critically examines the dual potential of digital health: while innovations such as telemedicine, mobile health applications, and electronic health records have, in certain contexts, expanded access, improved efficiency, and strengthened health system resilience, they have also exposed and exacerbated longstanding inequities. The analysis drawing on examples from both high-income and low- and middle-income countries, highlights how the digital divide rooted in disparities of infrastructure, affordability, digital literacy, and trust systematically excludes marginalized groups including the poor, elderly, rural residents, and people with disabilities. Case studies from diverse global settings reveal both the transformative promise of inclusive digital health initiatives and the persistent risks of digital exclusion. This positioning is particularly relevant to social, cultural, and nature-based prescribing, where digital systems may support referral, navigation, follow-up, and equity monitoring, but may also exclude populations with limited digital access, low digital literacy, disability, language barriers, or mistrust of digital platforms. To ensure digital health acts as a bridge, not a barrier, to UHC, this commentary reinforces and refines evidence-based policy recommendations previously proposed in the literature, updating them with insights from recent global health crises like COVID-19 and emerging data on digital exclusion. Building on established frameworks, we advocate for prioritizing inclusive design with a focus on intersectional barriers, investing in infrastructure and digital literacy tailored to post-pandemic recovery needs, enacting robust data protection regulations informed by recent cybersecurity challenges, fostering community engagement through localized trust-building models, and embedding equity-focused monitoring and evaluation using real-time, disaggregated data to address persistent gaps. These refinements aim to bridge the gap between high-level policy and actionable, context-sensitive implementation, enhancing their relevance and impact for achieving UHC. The conclusion underscores that digital health is not a panacea; its impact on health equity depends on deliberate, context-sensitive strategies that centre the needs of the most vulnerable. As health systems increasingly digitize, the imperative remains to ask: who benefits, and who is left behind? Only by addressing these questions can digital health truly advance the goal of health for all.
Grounded in the theory of Transactional Model of Stress and Coping, the study employed the explanatory correlational cross-sectional research design to investigate the predictive role of emotional intelligence (EI) on teaching anxiety (TA) level among preservice business teachers (PBTs). It also explored whether the relationship is moderated by gender. The census method was used to include all 107 PBTs and data was gathered using a close-ended structured questionnaire. Afterwards, linear regression and Hayes process moderation were employed for the analysis of the data obtained. The findings revealed that EI influences TA level among PBTs during teaching practicum (TP). Additionally, the study found that the gender of PBTs does not moderate the relationship between EI and TA level. The study recommends that stakeholders in teacher education be intentional about incorporating structured EI development into the preparation of future Business teachers (Accounting and Management) to help them better manage the emotional pressures associated with the practicum.
Cancer screening rates in refugee and immigrant populations are lower than the U.S.-born population. Interventions to ameliorate the disparity in cancer screening are needed. A retrospective review of N = 1083 patient charts was conducted to evaluate cancer screening rates for refugees and immigrants at an academic adult medicine clinic from June to December 2021. Language was used as a proxy for foreign-born status and a complete review of the electronic medical record conducted by a trained clinical team confirmed immigrant status and determined up-to-date cancer screening status. Descriptive statistics examined demographic factors and whether screenings for cervical, breast, colon, lung, and hepatocellular cancer were up-to-date with nationally accepted guidelines. Among eligible women, 63.0
The rapid growth in the use of digital technologies has led to increased exposure to cybercrime, with significant financial and psychological consequences. This study examines the behavioural and cognitive factors that affect cybercrime victimisation and its outcomes. Drawing on Cyber Routine Activity Theory (CRAT) and Protection Motivation Theory (PMT), the research examines the effects of digital lifestyle exposure, cybersecurity awareness, financial literacy, perceived susceptibility and risky online behaviours on cybercrime victimisation and financial loss and mental health deterioration. A quantitative research design was used with the aid of a structured questionnaire that was administered to 397 digitally active individuals and the data were analysed with the help of structural equation modelling (SEM). The results suggest that cybersecurity awareness, and risky online behaviours significantly influence on cybercrime victimisation, while digital lifestyle exposure, financial literacy and perceived susceptibility show no significant effects on cybercrime victimisation. Furthermore, cybercrime victimisation is found to have a significant contribution to financial loss and mental health deterioration and vice versa. These findings underscore the importance of behavioural practises in shaping cyber vulnerability and the link between the financial and psychological repercussions of cybercrime. The study adds to the literature by considering behavioural, financial, and psychological outcomes within a single framework and offers insights into the development of effective cybersecurity awareness and behavioural risk mitigation strategies.
Allergic rhinitis (AR) represents a prevalent and recurring health concern globally in a day to day life basis, affecting individuals across all age groups. Studies have proved that there has been a significant rise in its prevalence over the past few decades, making it one of the most common chronic respiratory disorders worldwide. The aim of this study is to analyse the burden of allergic rhinitis among the medical and paramedical students of Sikkim, evaluate common symptoms and various triggering factors, and to analyse the impact of AR on the performance of students on a day-to-day basis. This is a cross-sectional study carried out among the medical and paramedical students of Sikkim Manipal Institute of Medical Sciences (SMIMS), Sikkim Manipal College of Nursing (SMCON) and Sikkim Manipal College of Physiotherapy (SMCPT). After obtaining informed consent, participants were asked to complete a structured questionnaire in the form of google forms. The questionnaires answered were then analysed statistically. Among the 461 participants with mean age of 20.99 ± 1.78 years, 23.86
Artificial intelligence (AI) — spanning predictive risk models, large language models, algorithmic decision systems, and digital-care devices — is being deployed with increasing ambition across social welfare systems worldwide. Existing scholarship documents many resulting harms — bias, opacity, surveillance, erosion of discretion — but remains conceptually fragmented and rarely anchored in a framework specific to social work. This paper develops a tri-lens analytical matrix crossing three moral traditions (utilitarian, deontological, virtue-ethical) with AI’s two operational arenas (frontstage client-facing systems and backstage algorithmic administration) and four constitutive social-work values (privacy, self-determination, social justice, human dignity). Rather than assuming AI integration is either inevitable or uniformly beneficial, the framework asks: under what conditions — if any — can specific forms of AI function as augmented intelligence that extends relational practice, rather than as automated welfare that entrenches exclusion and erodes moral responsibility? The matrix is applied to three purposively selected cases — the Allegheny Family Screening Tool (US), algorithmic welfare administration (Dutch SyRI, Australian Robodebt, and Korean crisis-household detection), and digital-care technologies (Korea and OECD comparators) — whose cross-modal heterogeneity demonstrates that distinct AI modalities pose distinct ethical risks requiring distinct safeguards. The analysis shows that AI is ethically defensible in social work only when it augments practitioner judgment without displacing relational authority, advances substantive rather than merely formal equity, and is embedded in contestable, auditable institutions. The paper’s contribution is threefold: it reframes the field’s debate from replacement versus resistance to augmentation versus automation; supplies a reusable diagnostic matrix; and integrates Korean, European, and North American evidence within a single analytic lens anchored in social work’s commitments to relational practice, care ethics, and anti-oppressive praxis.
