A study was conducted to estimate the impact of hypertension screening on blood pressure measured 1, 2, and 3 years after baseline, as well as how its impact varies across socioeconomic statuses. Embedded within a subcohort of the ChinaHEART (China Health Evaluation and Risk Reduction Through Nationwide Teamwork) project, blood pressure was measured both at baseline and follow-up visits. Information about socioeconomic factors, including education, annual household income, occupational status, and urbanity, was also collected. A sharp regression discontinuity design was used to estimate the impact of hypertension screening on blood pressure measured 1, 2, and 3 years later. We also explored the role of baseline socioeconomic status by adding the interaction term. The regression discontinuity analysis found no effect of baseline hypertension screening on the primary outcomes. When stratified by socioeconomic status, regarding systolic blood pressure measured 1 year later, the impact of screening was 5.52 mm Hg (95% CI, -1.55 to 12.59) for individuals with primary or lower education, 0.80 mm Hg (95% CI, -4.00 to 5.59) for middle education, and -7.39 mm Hg (95% CI, -12.03 to -2.75) for high school or above education, with a significant trend observed (P for interaction=0.002). In addition, among individuals with high school or above education, the impact on systolic blood pressure 1, 2, and 3 years later was -7.39 mm Hg (95% CI, -12.03 to -2.75), -8.30 mm Hg (95% CI, -15.79 to -0.81), and -4.63 mm Hg (95% CI, -12.71 to 3.44), respectively. These patterns, although insignificant, were also found for other socioeconomic factors. The impact on diastolic blood pressure was smaller and insignificant. The impact of community-based hypertension screening on systolic blood pressure was affected by individual's education level and lasted only in the short term.

ABSTRACT This study uses American Community Survey data (2017–2022) to examine whether the educational composition of professional environments is associated with spouse selection. We find a significant positive association between the average education level of opposite-sex coworkers in an individual's occupation and industry and the educational attainment of the individual's spouse. This association is stronger for women and is substantially larger when spouses share the same occupation or industry. The findings show that workplace environments may contribute to educational homogamy and, in turn, to socioeconomic sorting.

Purpose This study examines public trust in traditional and religious leaders in Ghana, focusing on the influence of perceived corruption, engagement, responsiveness, and effective management of natural resources. Design/methodology/approach Employing data from the 9th Round of Afrobarometer surveys conducted in 2022, the study utilizes descriptive statistics and binary logistic regression analysis to investigate the factors that predict public trust in these non-state actors. Findings The findings reveal that perceived corruption does not significantly reduce trust in traditional and religious leaders, challenging simplistic assumptions about the relationship between corruption and institutional legitimacy. However, regular engagement, responsiveness to citizens' concerns, and the perception that natural resource extraction benefits the community are positively associated with increased trust. The study also highlights the importance of sociodemographic factors, with higher education levels and certain regions showing lower trust, while affiliation with the ruling party, general social trust, and feeling close to one's ethnic group are associated with higher trust. These results contribute to the understanding of the complex dynamics of trust in traditional and religious leadership in Ghana, offering insights for policymakers, leaders, and civil society organizations working on governance and social cohesion. Originality/value This study offers several original contributions to the understanding of public trust in traditional and religious leaders in Ghana: first, it provides a comprehensive quantitative analysis of factors influencing trust in traditional and religious leaders, addressing a gap in existing literature which has largely focused on qualitative or historical accounts. Second, the use of recent Afrobarometer data and robust statistical analysis adds to the empirical foundation of research in this area. Overall, this study advances our understanding of the complex and evolving role of traditional and religious leaders in modern Ghanaian society, challenging some existing assumptions while providing new insights into the factors that shape public trust in these important figures.

To investigate the association between daily toothbrushing and hand washing practices among Brazilian adolescent students. This cross-sectional study analysed data from the 2019 Brazilian National School-Based Health Survey. The sample comprised 120,054 schoolchildren aged 13-17 who completed an electronic questionnaire at school. The outcome variable was 'low toothbrushing frequency' (< twice/day). The independent variables were hand washing frequency before eating, after using the toilet, and with soap. The covariates were the adolescents' sociodemographic characteristics: sex, age, colour/race and their mother's level of education. Data analysis included Chi-square tests with Rao-Scott correction and logistic regression for complex samples. After adjustments, adolescents who rarely/sometimes and those who never washed their hands before eating were more likely to have a low brushing frequency (< twice/day) than those who most of the time/always washed their hands before eating. Similar results were found for hand washing after using the toilet and for washing with soap. Associations were found between oral and hand hygiene practices. Regardless of their sociodemographic characteristics, adolescents who reported infrequent hand washing were more likely to brush their teeth less frequently. These findings reinforce the importance of adopting a common risk factors approach to oral and general health in school health programmes.

Noted historian Mark Noll’s The Scandal of the Evangelical Mind identified and discussed the problem of anti-intellectualism in American evangelicalism (Noll 1994). I argue there is similarly a scandal of the Chinese evangelical mind. Indeed, anti-intellectualism is so persuasive and deep-rooted in the Chinese Church that many Christians perceive faith and knowledge as unrelated or opposed to each other, to the extent that one’s level of piety is often seen as inversely proportional to their level of education. In recent years, scholars have begun to pay attention to this phenomenon, offering valuable insights on the subject (Shi 2009; Chiow 2011; Ling 2009; Chen 2015). Overall, however, a precise definition of anti-intellectualism in the context of Chinese Christianity has not been provided; nor have the key characteristics of anti-intellectualism been adequately explained. In this essay, I want to offer a working definition of anti-intellectualism in the Chinese Church and provide an analysis of its main characteristics. But first I will contend that anti-intellectualism can be regarded as an “original sin” in the Chinese Church.

Background: Malaria in pregnancy (MiP) remains a major public health problem in sub-Saharan Africa, contributing to maternal anemia, placental insufficiency, low birth weight, and neonatal mortality. Nigeria bears a substantial proportion of the global malaria burden despite ongoing preventive interventions. Objective: To determine the prevalence of malaria and associated factors among pregnant women attending antenatal care in Onitsha, Anambra State, Nigeria. Methods: A cross-sectional hospital-based study was conducted among 125 pregnant women attending antenatal clinic at St. Charles Borromeo Specialist Hospital, Onitsha. Sociodemographic and clinical data were collected using structured questionnaires. Venous blood samples were examined for malaria parasites using Giemsa-stained thick blood smear microscopy. Data were analyzed using SPSS version 24. Chi-square test was used to assess associations, with statistical significance set at p &lt; 0.05. Results: The overall prevalence of malaria parasitemia was 37.6% (47/125). No statistically significant association was observed between malaria prevalence and age, marital status, occupation, educational level, trimester, exposure to mosquito-infested areas, use of insecticide-treated nets, or mosquito repellents (p &gt; 0.05). Parity demonstrated a statistically significant association with malaria prevalence (p = 0.0265), with multigravidae showing higher susceptibility. Conclusion: Malaria prevalence among pregnant women in Onitsha remains high. Parity is a significant determinant of infection, suggesting that parity may play a role and warrants further investigation in larger studies.

ABSTRACT Marine fishery management systems are experiencing unprecedented pressure from climate change. Prior research has identified adaptive traits that, when present in a management system, can promote effective responses to these changes and minimise negative outcomes for fish and fishery systems. Understanding the extent to which managers identify these traits as important and actively influencing management can identify gaps and opportunities for putting this theory into practice. To address this, we surveyed 321 fishery management professionals and scientists across all eight U.S. fisheries management regions. Questions focused on 16 adaptive traits related to topics such as systemic flexibility, opportunities for knowledge exchange and agency to act. For each trait, at least 68% of respondents identified the trait as important for supporting adaptation in their region. The two traits relating to fishermen and management's ability to learn and innovate were the most widely identified as important for adaptation. However, when asked about the role of management in influencing these traits, positive perceptions dropped by about 20% (at most 44% agreement per trait). Perceived importance and influence of adaptive traits significantly varied by the education level of survey respondents, with higher education levels correlating with higher perceived trait importance. Mapping this mismatch between perceived importance of adaptive traits and the ability of management to address them provides a blueprint for areas where a shared understanding of climate‐ready fishery goals would benefit both fishermen and regulators under future change.

Background and objective Age-related hearing loss (ARHL) is a significant risk factor for cognitive decline that can be mitigated using hearing aids (HAs). This study investigated the impact of HAs on cognitive function in ARHL, specifically targeting delayed recall and spatial orientation, and identified the influencing factors using multivariate logistic regression. Methods This is a cross-sectional study. A total of 104 ARHL patients from July 2023 to October 2025 were enrolled, dividing them into HA users (HA+ group, n = 47) and non-HA (HA− group, n = 57). The patients underwent audiological and cognitive assessments, including pure tone average (PTA), Montreal Cognitive Assessment (MoCA), and Mini-Mental State Examination (MMSE). Group comparisons were performed using these measures. Logistic regression was used to identify predictors of impaired delayed recall and spatial orientation, considering variables such as age, sex, HA+/− status, education, severity of hearing loss, depressive symptoms, living alone, smoking, alcohol consumption, diabetes, and hypertension. Results The HA + group had significantly better MoCA (24.49 ± 2.78 vs. 21.00 ± 3.63; Z = −4.881, p &amp;lt; 0.001) and MMSE (25.81 ± 2.45 vs. 23.33 ± 3.33; Z = −4.118, p &amp;lt; 0.001) scores than the HA- group, notably in delayed recall ( Z = −2.653, p = 0.008) and spatial orientation ( Z = −3.643, p &amp;lt; 0.001). HAs were a significant protective factor for both delayed recall [OR = 0.271, 95% confidence interval (CI) = (0.080, 0.914)] and spatial orientation [OR = 0.233, 95% CI = (0.066, 0.823)]. Additionally, higher educational levels were associated with better cognitive function. Discussion HAs improved cognitive function in patients with ARHL, especially in terms of delayed recall and spatial orientation, with education offering additional protection.

Abstract Cognitive testing is an important part of dementia assessment. Widely used instruments such as the MMSE and MoCA are limited by language and educational biases. The Rowland Universal Dementia Assessment Scale (RUDAS) was developed to overcome these barriers. We conducted a systematic review and meta-analysis of cross-sectional studies evaluating RUDAS against established diagnostic criteria for all-cause dementia. Case-control designs were excluded to minimise spectrum bias. Sensitivity and specificity estimates were pooled using a bivariate random-effects model. Eleven studies from nine countries were included (n = 3607). In secondary healthcare settings, pooled sensitivity was 84% (95%CI:70–92) and specificity 70% (95%CI:57–80) at the recommended threshold (22/23). Results from community-based studies could not be pooled for a summary measure. Educational levels influenced optimal cut-points. RUDAS demonstrates reasonable diagnostic accuracy but is affected by education. There is an urgent need to develop normative data for use in different settings.

Blended learning has become an increasingly prominent and popular teaching-learning approach in different levels of education, especially in the post-pandemic era (COVID-19). Blended learning is a pedagogical approach that has come with the innovation of science and technology. It combines face-to-face instruction with online learning components to provide greater flexibility and accessibility for learners. This study examined the attitude of students and teachers towards blended learning and explored its practical implementation at higher educational institutions. Using a descriptive survey design, data were collected from 264 undergraduate students and 176 teachers through a structured attitude scale and questionnaire. The findings of the research revealed that the majority of students and teachers hold a favourable attitude towards blended learning, recognizing its flexibility, feasibility in evaluation, accessibility of teaching-learning resources, and self-directed learning. However, despite this, the actual use of blended learning strategies in regular classroom teaching-learning process was found to be limited and not fully aligned with its intended pedagogical potential. However, challenges such as limited technological exposure, insufficient training, low tech-literacy, lack of awareness, inadequate infrastructural facilities of the institution, and lack of interest in preparing digital teaching material were also found among both the teachers and students.

Does What Doctors Wear Really Matter? The DRESS Prospective Study on Patient Trust.

The present study examines the acquisition of English articles by Urdu L1 speakers in Pakistan, focusing on the use of definite articles. As seen in Hawkins and Towell (1994), the existing studies highlights the challenges that L2 learners face in case they do not have an equivalent article system in their L1, Master (1995) emphasizes the role of explicit instruction in facilitating article acquisition, and Ionin (2009) examines the role of the quality of input in L2 article learning, concluding that the amount and type of English exposure have a significant effect on how well learners master articles. However, it is found out that acquiring articles can be very difficult for L2 learners when their L1 is does not have an equivalent structure like the article-less languages of Urdu, Japanese and Korean. The current research explores whether the problem of article learning is similar in different age groups of participants i.e. adolescents (9-19 years old) and adults (20 years old or higher). For this purpose, 100 participants were taken. Following the Fluctuation Hypothesis (FH) by Ionin (2004), as a theoretical framework, the study identified the degree to which learners vary in their patterns of use of articles and how various input patterns influence proficiency. In addition, the research also examined the effect of level and grades of education at which start learning English, no of years of learning English and the effect of Mother tongue on the accuracy of the learners in the articles. The Data were collected by using elicitation test and a judgment task based on Ionin's (2004) methodology to assess learners' accuracy in using definite articles. The findings focus on how the age, educational level, and knowledge of languages interact and influence the acquisition of articles within L2 English regarding the stages when learners develop proficiency overcoming interference, overgeneralization and overuse. The findings not only enrich our understanding of the L2 article use, but also give practitioners, including L2 English teachers and learners, empirically based advisory on instructions design improvements and learning maximization.

Anxiety levels and associated sociodemographic factors in mothers of children with first febrile seizures: A case-control study.

Adults with intellectual disabilities (IDs), particularly those who reside in community living arrangements (CLAs), are at high risk for these chronic diseases. Sedentary behaviour (SB) is an emergent, independent risk factor for several chronic diseases including cardiovascular and metabolic conditions. SB may represent a potent behavioural target to mitigate chronic disease risk in adults with ID who live in CLAs. Limiting the development of interventions to address SB is a lack of understanding of device-estimated SB patterns. Also not clear are the individual-level determinants of SB in this high-risk group of CLA residents with ID. The current study sought to address these knowledge gaps. A cross-sectional observational study design was used to characterize SB patterns and individual-level determinants of SB in adults with ID living in CLAs. Thirty-eight adults from 24 different CLAs wore activPAL devices for 1 week to enable device estimates of SB. activPAL data were processed, and the study outcomes of daily time spent in SB, SB bout lengths, sedentary breaks and prolonged SB were generated. Participants also completed an online survey to assess individual factors, which included demographics, independence, programming and health status. Univariate statistics were used to describe SB patterns and logistic regression models were used to ascertain the association between individual factors and SB variables. On average, the sample were aged 44.79 years (SD = 14.9), and 60.53% were male. The sample were highly sedentary: 47.37% engaged in prolonged SB, the daily average time in SB was 7.46 h (SD = 2.18), and an average of 32.4 daily SB bouts (95% CI = 28.9, 35.9) lasted 17.7 min (95% CI = 13.8, 21.7). Participants requiring more assistance with ADLs were more likely to have longer uninterrupted sedentary bouts (95% CI = 0.169, 1.721; β = 0.945; p = 0.018) and total daily duration of SB (95% CI = 4.58, 20.21; β = 12.394; p = 0.003). Those with less than a high school education had sedentary bouts that were ~15 min longer (95% CI = 3.21, 25.69; p = 0.013). Adults with ID living in CLAs spent almost 8 h of their waking day in SB. Those with lower levels of independence and education were more likely to have higher levels of SB. CLAs may represent a critical opportunity for targeted, place-based interventions to reduce time spent in SB.

ABSTRACT This study set out to explore a longitudinal data set of 4915 adults (49.6% females) examining the effects of parental social status/class (measured at birth), childhood intelligence (at age 10), teenager locus of control (at age 16), psychological distress (at age 30), educational qualifications (at age 34), occupational level (at age 38), number of health conditions experienced and self-assessed physical health measures (all at age 42). Correlational analysis showed all these factors were significantly associated with adult physical health measures. Structural equation modelling showed that, apart from health conditions (which was significantly and negatively associated with the outcome variable), teenager locus of control, adult psychological distress, educational qualifications and occupational levels all had significant and direct effects on adult physical health (indicated by good daily physical functioning, relative absence of pain, and perceived health), accounting for 35% of the total variance. Mediation analyses showed that the effects of parental social status and childhood intelligence on adult physical health in part, mediated through educational qualifications and occupational levels. Childhood intelligence predicted adult physical health mediating through teenager locus of control. Implications and limitations are discussed.

Despite the current recommendation of human papillomavirus (HPV) vaccination for girls and boys, vaccination rates in Germany remain low. Vaccination awareness is essential for vaccination behaviour and thus for an increase in vaccination rates. The aims of the present work were to investigate HPV vaccination awareness among the general population in Germany and to identify potential factors (sociodemographic, family and relationship characteristics, regional context) associated with HPV vaccination awareness. The results will help to conceptualize, manage, optimize and evaluate measures of public health. As part of the LIEBESLEBEN study, population-wide data were collected via an online survey (n = 4640). Data were weighted according to criteria representative for Germany. Bivariate analyses and multivariate logistic regression models were calculated. In total, 61.5% of respondents are aware of HPV vaccination for girls and 32.6% are aware of HPV vaccination for boys. The results of regression analyses show that the awareness of HPV vaccination for girls and boys is significantly associated with gender, formal education level, sexual orientation and living with children. The awareness of HPV vaccination for girls is additionally associated with relationship status and the degree of regional deprivation. In addition, HPV vaccination awareness for boys is associated with age. In Germany, HPV vaccination awareness is still modest. This is particularly true in terms of vaccination for boys. Measures to raise awareness should be intensified. These include communication and informational offerings, settings-based approaches to address target groups as well as involving (medical) professionals, and supporting ahealthcare structure that promotes vaccination.

To foster academic integrity in students and future scholars, it is essential to understand how their integrity behaviours evolve throughout their educational trajectory and across various academic integrity topics. While much research has examined students' perception of and engagement in plagiarism and other forms of clear-cut cheating, grey-zone practices have largely been neglected, and comparisons across educational levels are rare. This paper presents a comprehensive overview of European students' conceptions of and engagement with less clearcut aspects of academic integrity, and the potential effects of academic integrity training. The study draws on a large-scale survey of 3,297 students from Denmark, Ireland, Portugal, and Switzerland, covering three educational levels (upper secondary, Bachelor, and PhD). The survey examined perceptions of and engagement in likely grey-zone and non-compliant practices across three dimensions of academic integrity: i) Plagiarism and citation practice, ii) Collaborative practices, and iii) Data collection and analysis. Responses were analysed using descriptive statistics and regression analyses. Results showed that participants at higher educational levels were better at identifying likely non-compliant practices related to plagiarism and citation, and they were less likely to have engaged in such practices during their current studies. Progress along the educational trajectory was less pronounced regarding collaborative practices and practices related to data collection and analysis. In particular, 14% of the PhD level participants admitted having deleted deviating data "based on a gut feeling that they were inaccurate" and 20% admitted to keeping inaccurate records. All participants had a low level of competence in identifying grey-zone practices, and strikingly, their competences did not improve along their educational trajectory. Academic integrity training was not consistently correlated with any group of participants' competences regarding likely grey-zone practices, although it was positively correlated with upper secondary and PhD participants' competences concerning certain likely non-compliant practices. These results call for a different approach to academic integrity training. In particular, they call for more comprehensive approaches that include grey-zone as well as non-compliant practices, and address a broad range of questionable behaviours, not only plagiarism.

Oral health is an essential component of overall health and quality of life; however, utilisation of professional dental care services remains low in many rural communities in Nigeria. Knowledge and attitudes toward dental care are key determinants of service utilisation, particularly in underserved populations. This study assessed the knowledge, attitudes, and utilisation of professional dental care services among rural residents of Ikwerre Local Government Area, Rivers State, Nigeria. Method: A community-based cross-sectional study was conducted among 300 rural residents selected using multistage sampling. Data were collected using a structured interviewer-administered questionnaire. Descriptive statistics were used to summarize respondents’ knowledge, attitudes, and utilisation of dental care services, while Chi-square tests were used to examine associations between socio-demographic characteristics and knowledge and attitudes. Statistical significance was set at p &amp;lt; 0.05. Result: Most respondents demonstrated good knowledge of oral/dental health (84.3%). Despite this, attitudes toward dental care utilisation were largely negative, with 63.7% of respondents exhibiting unfavourable attitudes. Utilisation of professional dental care services was generally low and largely symptom-driven. Sex and monthly income were significantly associated with knowledge of oral/dental health (p &amp;lt; 0.05). Attitude toward dental care utilisation was significantly associated with level of education, occupation, and monthly income (p &amp;lt; 0.001), while age, marital status, and sex showed no significant association. Conclusion: Although knowledge of oral health was relatively high among rural residents of Ikwerre Local Government Area, negative attitudes toward dental care and low utilisation of professional services persist. Socioeconomic factors play a significant role in shaping attitudes and knowledge, underscoring the need for targeted oral health education, attitude-focused interventions, and improved accessibility and affordability of dental services in rural communities.

Long COVID is a condition characterized by persistent symptoms of COVID-19 that continue to occur in patients after apparent recovery. Given that, these symptoms may vary from person to person due to clinical, demographic, and genetic factors as well as comorbidities, our review aims to identify and analyze risk factors associated with persistent symptoms of COVID-19 (long COVID) in the specific context of sub-Saharan Africa. Article searches were conducted in the PubMed, Scopus, African Journals Online (AJOL), Science Direct and Google Scholar databases using the keywords "long COVID" or "long-term COVID-19" or "post-COVID condition" or "post-acute sequelae of COVID-19" and "sub-Saharan Africa" or "sub-Saharan Africans". The obtained data were entered into software for duplication checking. Two reviewers selected and extracted the data. Due to substantial heterogeneity in definitions and study designs, a narrative synthesis approach was adopted. Fifteen studies were included in this review, totaling 8,233 participants previously infected with SARS-CoV-2, with approximately 2,011 patients with long COVID from six countries. Six studies were cross-sectional, three were retrospective, three were cohort studies, two were case-control, and one was a case report. The review found that the prevalence of long COVID in sub-Saharan Africa ranged from 2% in Ghana to 66.7% in South Africa. The persistent COVID-19 symptoms most commonly experienced by people living in sub-Saharan Africa were fatigue (reported in 12 studies, 25-66% of patients), cough (7 studies, 9-86%), chest pain (9 studies, 9%-29%), dyspnea (10 studies, 15-45%), palpitations (4 studies, 10-30%), headache (9 studies, 12-38%), and cognitive impairment (6 studies, 8-20%). The main risk factors for the occurrence of persistent COVID-19 symptoms were older age (˃ 60 years), female sex, low education level, hypertension, type 2 diabetes, cardiovascular disease, length of hospitalization during the acute episode, number of initial COVID-19 symptoms, and initial disease severity. Long COVID is a reality in sub-Saharan Africa. Fatigue and hypertension have proven to be the most common symptom and risk factor, respectively. The heterogeneity of long COVID definitions across studies limits direct prevalence comparisons. Given the socio-economic challenges, pre-existing comorbidities and differences in health systems in the sub-Saharan region, it is therefore necessary to develop new strategies for care, rehabilitation and treatment (specific to the realities of the sub-Saharan region) targeted at each persistent symptom of COVID-19 in order to resolve this emerging problem and allow patients to have a good quality of life. Not applicable.

Background Service quality is a critical determinant of satisfaction and behavioral intentions in fitness centers. Instructors play a pivotal role in shaping users’ perceived quality and, consequently, their loyalty and recommendation intentions. This study aimed to compare users’ ratings of quality of intervention, loyalty intention, and recommendation intention with instructors’ estimations of how users would rate these same dimensions, and to examine how users’ ratings vary according to sex, age, educational level, and gym attended. Methods A total of 589 users and 145 instructors from five gyms within a Portuguese fitness chain completed an online questionnaire in which users rated quality of intervention, loyalty intention, and recommendation intention, while instructors reported their estimations of how users would rate these same dimensions, rather than providing their own evaluations. Independent samples t -tests and one-way ANOVA were performed to compare perceptions between users and instructors, and across user groups by sex, age, education level, and gym attended. Results Users consistently rated instructor quality, loyalty, and recommendation intentions higher than instructors did. Among users, significant differences were found across age, education level, and gym attended: older and less-educated participants, and those from specific gyms, reported higher scores. Only recommendation intention differed by sex, with female users more frequently reporting that they would recommend the gym. Conclusion This study highlights the crucial role of instructor quality in shaping satisfaction and behavioral intentions within fitness settings. The results emphasize the importance of reflective professional development for instructors and segmentation-based loyalty strategies for users. These findings offer actionable insights for fitness managers to tailor service delivery, strengthen customer loyalty, and foster sustainable organizational success in a competitive market.