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Abstract Background Knowledge of the fertility period aids women in refraining and engaging in sexual intercourse to avoid and to get pregnant, respectively. The effect of community-level factors on knowledge of the fertility period was not yet known in Kenya. Therefore, we aimed to investigate the community- and individual-level determinants of knowledge of fertility period among women of childbearing age in Kenya. Methods The 2022 Kenyan Demography and Health Survey data was used for the current study. This study included 16,901 women of reproductive age. To account for the clustering effects of DHS data and the binary nature of the outcome variable, a multilevel binary logistic regression model was applied. An adjusted odds ratio with a 95% confidence interval was reported to declare the statistical significance. In addition, the model that had the lowest deviance was the one that best fit the data. Results The overall prevalence of knowledge of the fertility period among Kenyan women was 38.1% (95%CI = 37.3, 38.9). Women’s age, women’s education status, heard FP, contraceptive use, media exposure, and distance from health facility significant individual factors while place of residence, and community-level education, were all of factors were found to be strongly associated with knowledge of fertility period. Conclusion As per the findings of our study, Knowledge of the fertility period among reproductive women was low in Kenya. In the era of increasing refusal of hormone-based family planning, fertility-awareness-based family planning methods may be an option. Promoting the correct fertility period through education and media outreach may be helpful strategies for enhancing fertility decision-making.

Abstract Background Teenage pregnancy is becoming one of the most common social and public health problems worldwide, with the highest prevalence in sub-Saharan Africa. Health risks and adverse outcomes of pregnancy and childbirth among adolescent girls are the commonest cause of the global burden of maternal morbidity and mortality. This study is intended to determine the pooled prevalence and determinants of teenage pregnancy in sub-Saharan Africa using the most recent demographic and health survey data (2019–2022). Methods A cross-sectional study was conducted using data from the most recent demographic and health surveys of four countries (Kenya, Tanzania, Gabon, and Cameroon) in sub-Saharan Africa conducted between 2019 and 2022. A total weighted sample of 12,829 teenagers aged 15 to 19 years was included in the study. Data extracted from demographic and health survey data sets were cleaned, recorded, and analyzed using STATA/SE version 14.0 statistical software. Multilevel mixed-effects logistic regression was used to determine the factors associated with the dependent variable. Finally, variables with a p-value ≤ 0.05 and an adjusted odds ratio with a 95% confidence interval were declared statistically significant. Results The pooled prevalence of teenage pregnancy among women aged 15 to 19 years was 18.15% (95% CI: 17.49, 18.83). Teenage pregnancy was positively associated with the respondent’s age [AOR = 2.97; 95% CI (2.55, 3.46)], educational status [AOR = 2.21; 95% CI (1.62, 3.03)] and [AOR = 1.80; 95% CI (1.54, 2.12)], wealth status [AOR = 2.61; 95% CI (2.12, 3.22)] and [AOR = 1.65; 95% CI (1.33, 2.05)], relation to the household head [AOR = 2.09; 95% CI (1.60, 2.72)], and unmet need for contraception [AOR = 14.3; 95% CI (11.5, 17.8)]. On the other hand, it was negatively associated with marital status [AOR = 0.08; 95% (0.07, 0.10)], working status [AOR = 0.75; 95% CI (0.64, 0.88)], age at first sex [AOR = 0.68; 95% CI (0.58, 0.80)], contraceptive use [AOR = 0.25; 95% CI (0.20, 0.30)], contraceptive knowledge [AOR = 0.27; 95% CI (0.19, 0.40)], and community contraceptive utilization [AOR = 0.85; 95% CI (0.73, 0.99)]. Conclusion In the current study, one out of six young women aged 15 to 19 experienced teenage pregnancy. Therefore, addressing unmet needs for family planning, improving women’s educational status, and giving special attention to teenagers with low educational and economic status are recommended.

Abstract Introduction Even though childhood diarrhea is treated with a simple treatment solution, it continues to be one of the leading causes of under-five child mortality and malnutrition globally. In resource-limited settings such as Sub-Saharan Africa (SSA), the combination of oral rehydration salts (ORS) and zinc is regarded as an effective treatment for diarrhea; however, its utilization is very low. The purpose of this study was to determine the proportion and associated factors of co-utilization of ORS and zinc among under-five children with diarrhea in SSA. Methods The proportion and associated factors of co-utilization of ORS and zinc among under-five children with diarrhea in SSA were determined using secondary data analysis of recent Demographic and Health Surveys (DHS) of 35 SSA countries. The study included a total of 44,341 under-five children with diarrhea in weighted samples. A generalized linear mixed-effects model with robust error variance was used. For the variables included in the final model, adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) were estimated. A model with the lowest deviance value were considered as the best-fitted model. Result The pooled proportion of co-utilization of ORS and zinc for the treatment of diarrhea among under five children in SSA countries was 43.58% with a 95% CI (43.15%, 44.01%). Sex of the child, maternal age, residence, maternal educational and employment status, wealth index, media exposure, perceived distance to health facility and insurance coverage were statistically significant determinants of ORS and Zinc co-utilization for treating diarrhea among under five children in SSA. Conclusion Only less than half of under-five children with diarrhea in SSA were treated with a combination of ORS and zinc. Thus, strengthening information dissemination through mass media, and community-level health education programs are important to scale up the utilization of the recommended combination treatment. Furthermore, increasing health insurance coverage, and establishing strategies to address the community with difficulty in accessing health facilities is also crucial in improving the use of the treatment.

The literature on tourist experience commonly puts the current en-route experience at the center stage through single-level analysis. This research steers away from that tradition to improvise a triple-experience model through multiple inquiries. Data were collected from a survey to assess how prior and current travel app usage experiences could impact app-induced site attitude and revisit intention via the app, based on a multilevel design with survey data collected from 21 sites. The cross-level moderation of others’ experiences was also explored. This research draws on the functional theory of attitude and the theory of normative conduct to acknowledge the knowledge and social functions of attitude change. It contributes to the literature by bridging the divide between the online app and offline travel evaluations. It builds a theoretical synthesis between the aforementioned theoretical lens to demonstrate how the experiences of others through travel apps can impact an individual’s experience, ultimately affecting attitude toward app-induced tourism destinations. [ABSTRACT FROM AUTHOR]

Introduction: Adolescents face unique challenges related to their sexual and reproductive health (SRH), with access to timely services being critical for positive outcomes. However, SRH service utilization among adolescents remains low. This study aimed to identify factors influencing SRH service use among adolescents in Gamo Zone, Ethiopia. Methods: A community-based cross-sectional study involved 1172 adolescents selected through stratified sampling. Structured face-to-face interviews were employed for data collection. Multilevel mixed logistic regression was fitted to identify factors and latent class analysis was conducted to understand population heterogeneity. Results: The findings of this study reveal that 198 (16.89%) adolescents (95% CI: 14.8%-19.2%) utilized SRH services within the past 12 months. Factors significantly associated with SRH service utilization included good knowledge about SRH rights (AOR = 4.65; 95% CI: 2.68, 8.07), belonging to one-parent families (AOR = 4.13; 95% CI: 2.39, 7.12), engaging in parental discussions regarding SRH issues (AOR = 3.17; 95% CI: 1.89, 5.29), high family support (AOR = 1.96; 95% CI: 1.09, 3.51), and enrolling in school (AOR = 0.19; 95% CI: 0.11, 0.33). Additionally, access to social media was associated with increased SRH service utilization among adolescents (AOR = 1.98; 95% CI: 1.25, 3.15). Latent class analysis identified four groups: rural school-enrolled adolescents living with parents, urban school-enrolled adolescents with both parents, urban disadvantaged female adolescents, and early adolescents with limited social media access. Conclusions: In conclusion, our study sheds light on the utilization of SRH services among adolescents, revealing that 16.89% of the participants accessed these services within the past year. Significant factors associated with SRH service utilization included good knowledge about SRH rights, belonging to one-parent families, engaging in parental discussions regarding SRH issues, high family support, and enrollment in school. Interestingly, access to social media was also linked to increased utilization of SRH services among adolescents. Furthermore, our latent class analysis identified four distinct classes of adolescents based on socio-demographic indicators, highlighting the heterogeneity within this population. These findings underscore the importance of tailored interventions and targeted approaches to address the diverse needs of adolescents in accessing and utilizing SRH services. [ABSTRACT FROM AUTHOR]

This article analyses the driving factors behind the formation of individual work values in European welfare states. By comparing relative preferences for extrinsic and intrinsic work values, we shed light on the discussion of the effects of intergenerational transmission and the structuring effects of labour market policies and regional opportunity structures on the formation of work values. Therefore, a multilevel analysis is applied using the innovative CUPESSE data set, which provides data on young adults and their parents in 65 NUTS‐1‐regions from 11 European countries. The results show that individual work values of young Europeans are most substantively shaped by the respective values of their parents. Furthermore, we demonstrate that individual characteristics such as sex, education and personal unemployment experiences determine preferences for work values. Finally, the paper shows that the local labour market context and welfare state arrangements also play a decisive role in the formation of individual work values. [ABSTRACT FROM AUTHOR]

Developing a measurement of grateful climate is an essential step to examining the function of a grateful climate in a team or group context. Accordingly, the purpose of this study was to develop a valid and reliable measure of the grateful climate of sports teams. We defined the grateful climate of sports teams as a culturally shaped perception that team members collectively exhibit values, beliefs and expected behaviors that fit with the script of gratitude. Exploratory factor analysis and multilevel confirmatory factor analysis were conducted to evaluate the validity and reliability of the Sports Team Grateful Climate Questionnaire. In addition, nomological validity and incremental validity were also examined. The results indicated that the 9-item Sports Team Grateful Climate Questionnaire has good convergent validity, nomological validity, and incremental validity. We concluded that it can be a useful tool for future studies aiming to better understand grateful climate in sports teams. [ABSTRACT FROM AUTHOR]

Objective Physical activity is recommended for recipients of a kidney transplant. However, ADHERE BRAZIL study found a high prevalence (69%) of physical inactivity in Brazilian recipients of a kidney transplant. To tackle this behavior, a broad analysis of barriers is needed. This study aimed to identify factors (patient and transplant center levels) associated with physical inactivity among recipients of a kidney transplant. Methods This was a subproject of the ADHERE BRAZIL study, a cross-sectional, multicenter study of 1105 recipients of a kidney transplant from 20 kidney transplant centers. Using a multistage sampling method, patients were proportionally and randomly selected. Applying the Brief Physical Activity Assessment questionnaire, patients were classified as physically active (≥150 min/wk) or physically inactive (<150 min/wk). On the basis of an ecological model, 34 factors associated with physical inactivity were analyzed by sequential logistic regression. Results At the patient level, physical inactivity was associated with smoking (odds ratio = 2.43; 95% CI = 0.97–6.06), obesity (odds ratio = 1.79; 95% CI = 1.26–2.55), peripheral vascular disease (odds ratio = 3.18; 95% CI = 1.20–8.42), >3 posttransplant hospitalizations (odds ratio = 1.58; 95% CI = 1.17–2.13), family income of >1 reference salary ($248.28 per month; odds ratio = 0.66; 95% CI = 0.48–0.90), and student status (odds ratio = 0.58; 95% CI = 0.37–0.92). At the center level, the correlates were having exercise physiologists in the clinical team (odds ratio = 0.54; 95% CI = 0.46–0.64) and being monitored in a teaching hospital (undergraduate students) (odds ratio = 1.47; 95% CI = 1.01–2.13). Conclusions This study identified factors associated with physical inactivity after kidney transplantation that may guide future multilevel behavioral change interventions for physical activity. Impact In a multicenter sample of recipients of a kidney transplant with a prevalence of physical inactivity of 69%, we found associations between this behavior and patient- and center-level factors. At the patient level, the chance of physical inactivity was positively associated with smoking, obesity, and patient morbidity (peripheral vascular disease and hospitalization events after kidney transplantation). Conversely, a high family income and a student status negatively correlated with physical inactivity. At the center level, the presence of a dedicated professional to motivate physical activity resulted in a reduced chance of physical inactivity. A broad knowledge of barriers associated with physical inactivity can allow us to identify patients at a high risk of not adhering to the recommended levels of physical activity. [ABSTRACT FROM AUTHOR]

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Background: We aimed to measure the variance due to examination conditions during the first sessions of objective structured clinical examinations (OSCEs) performed at a French medical school and identify factors associated with student success. Methods: We conducted a retrospective, observational study using data from the first three OSCEs sessions performed at Paris-Saclay medical school in 2021 and 2022. For all sessions (each organized in 5 parallel circuits), we tested a circuit effect using a linear mixed-effects model adjusted for sex and the average academic level of students (according to written tests). Then, we studied the factors associated with student success at one station using a multivariate linear mixed-effects model, including the characteristics of students, assessors, and standardized patients. Results: The study included three OSCEs sessions, with 122, 175, and 197 students and a mean (± SD) session score of 13.7(± 1.5)/20, 12.7(± 1.7)/20 and 12.7(± 1.9)/20, respectively. The percentage of variance due to the circuit was 6.5%, 18.2% (statistically significant), and 3.8%, respectively. For all sessions, the student's average level and station scenario were significantly associated with the score obtained in a station. Still, specific characteristics of assessors or standardized patients were only associated with the student's score in April 2021 (first session). Conclusion: The percentage of the variance of students' performance due to the examination conditions was significant in one out of three of the first OSCE sessions performed at Paris-Saclay medical school. This result seems more related to individual behaviors rather than specific characteristics of assessors or standardized patients, highlighting the need to continue training teaching teams. National clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Although the acceptance of educational apps and their contributions to learning have been widely researched, none of these studies have examined links between teachers' acceptance of apps and their students' skills. The present study investigated this issue with respect to a new, French-language educational app for helping preschool children improve their early literacy and early numeracy skills. To this end, we measured the app's acceptance by 33 French preschool (école maternelle) teachers, who used it in class for ten weeks, and the early literacy and early numeracy skills of their 353 students (aged between 3.92 and 4.91 years). Multilevel regression analyses revealed a significant link between the students' post-test early literacy and early numeracy scores and their teachers' perception of the app's usability. These results show that taking teachers' acceptance into account is an interesting opportunity to better understand the potential effectiveness of educational apps in school settings. Implications for teachers' training are also discussed. [ABSTRACT FROM AUTHOR]

Background: Poor infant and child feeding practices, in combination with increased rates of infectious diseases, are the main immediate causes of malnutrition during the first two years of life. Non-breastfed children require milk and other dairy products, as they are rich sources of calcium and other nutrients. As far as our search is concerned, there is no evidence on the pooled magnitude and determinants of minimum milk feeding frequency among non-breastfed children in sub-Saharan Africa conducted using the most recent indicators for assessing infant and young child feeding practices published in 2021. Therefore, this study is intended to determine the magnitude and associated factors of minimum milk feeding frequency among non-breastfed children aged 6–23 months in sub-Saharan Africa using the most recent guideline and demographic and health survey dataset. Methods: Data from the most recent health and demographic surveys, which were carried out between 2015 and 2022 in 20 sub-Saharan African countries, were used. The study comprised a weighted sample consisting of 13,315 non-breastfed children between the ages of 6 and 23 months. STATA/SE version 14.0 statistical software was used to clean, recode, and analyze data that had been taken from DHS data sets. Utilizing multilevel mixed-effects logistic regression, the factors associated with the outcome variable were identified. Model comparison and fitness were assessed using deviance (-2LLR), likelihood ratio test, median odds ratio, and intra-class correlation coefficient. Finally, variables with a p-value < 0.05 and an adjusted odds ratio with a 95% confidence interval were declared statistically significant. Results: The pooled magnitude of minimum milk feeding frequency among non-breastfed children aged 6–23 months in sub-Saharan African countries was 12.39% (95% CI: 11.85%, 12.97%). Factors like maternal educational level [AOR = 1.61; 95% CI (1.35, 1.91)], marital status of the mother [AOR = 0.77; 95% CI (0.67, 0.89)], maternal working status [AOR = 0.80; 95% CI (0.71, 0.91)], media exposure [AOR = 1.50; 95% CI (1.27, 1.77)], wealth index [AOR = 1.21; 95% CI (1.03, 1.42)], place of delivery [AOR = 1.45; 95% CI (1.22, 1.72)], ANC visit attended during pregnancy [AOR = 0.49; 95% CI (0.39, 0.62)], PNC checkup [AOR = 1.57; 95% CI (1.40, 1.76)], child's age [AOR = 0.70; 95% CI (0.53, 0.93)], and residence [AOR = 2.15; 95% CI (1.87, 2.46)] were significantly associated with minimum milk feeding frequency. Conclusions: In sub-Saharan Africa, the proportion of minimum milk feeding frequency among non-breastfed children aged between 6 and 23 months was low. The likelihood of minimum milk feeding frequency increases with high levels of education, unemployment, media exposure, rich wealth status, being unmarried, having a child born in a health facility, getting PNC checks, being between 6 and 8 months old, and living in an urban area. Hence, promoting women's education, increasing the economic status of the household, disseminating nutrition information through media, strengthening maternal health service utilization like health facility delivery and PNC services, and giving prior attention to mothers with older children and from rural areas are strongly recommended. [ABSTRACT FROM AUTHOR]

Background: Patients who receive invasive mechanical ventilation (IMV) in the intensive care unit (ICU) have exhibited lower in-hospital mortality rates than those who are treated outside. However, the patient-, hospital-, and regional factors influencing the ICU admission of patients with IMV have not been quantitatively examined. Methods: This retrospective cohort study used data from the nationwide Japanese inpatient administrative database and medical facility statistics. We included patients aged ≥ 15 years who underwent IMV between April 2018 and March 2019. The primary outcome was ICU admission on the day of IMV initiation. Multilevel logistic regression analyses incorporating patient-, hospital-, or regional-level variables were used to assess cluster effects by calculating the intraclass correlation coefficient (ICC), median odds ratio (MOR), and proportional change in variance (PCV). Results: Among 83,346 eligible patients from 546 hospitals across 140 areas, 40.4% were treated in ICUs on their IMV start day. ICU admission rates varied widely between hospitals (median 0.7%, interquartile range 0–44.5%) and regions (median 28.7%, interquartile range 0.9–46.2%). Multilevel analyses revealed significant effects of hospital cluster (ICC 82.2% and MOR 41.4) and regional cluster (ICC 67.3% and MOR 12.0). Including patient-level variables did not change these ICCs and MORs, with a PCV of 2.3% and − 1.0%, respectively. Further adjustment for hospital- and regional-level variables decreased the ICC and MOR, with a PCV of 95.2% and 85.6%, respectively. Among the hospital- and regional-level variables, hospitals with ICU beds and regions with ICU beds had a statistically significant and strong association with ICU admission. Conclusions: Our results revealed that primarily hospital and regional factors, rather than patient-related ones, opposed ICU admissions for patients with IMV. This has important implications for healthcare policymakers planning interventions for optimal ICU resource allocation. [ABSTRACT FROM AUTHOR]

Objective: In view of the increasing number of people with (multiple) chronic conditions, the Organisation for Economic Co-operation and Development (OECD) initiated the International Survey of People Living with Chronic Conditions (PaRIS survey), which aims to provide insight in patient-reported outcomes and experiences of chronic care provided by primary care practices to support policy development. The objective of this research note is to describe the structure of the data, collected in the PaRIS survey and how the data will be analysed in a multilevel approach for cross-country comparison. Analysis plan: The data structure of the PaRIS survey represents three levels: countries/health systems, primary care practices and patients. Multilevel analysis is used because of its accuracy in estimating country-level outcomes, its flexibility in modelling relationships, and its opportunities in connecting to relevant policy questions. Country-level outcomes will be estimated to facilitate cross-country comparison and (future) within-country comparison over time. Characteristics of patients that potentially explain variation in patient-reported outcomes and experiences can be linked to primary care practice and country/health system characteristics. This makes it possible to address policy-relevant questions relating, e.g., to the impact of chronic care management on patients with a specific chronic condition. [ABSTRACT FROM AUTHOR]

The psychosocial correlates and consequences of peer victimization are well documented. However, there is limited knowledge about whether different forms of peer victimization (relational and physical) are predictive of school-based social and motivational factors among adolescents from non-Western cultures. The present study examined the relationship between individual and school-level forms of peer victimization and school adjustment among Japanese adolescents, and the mediating role that these factors may play. The Japanese sample (N = 6109 from 185 schools, Mage = 15.78, SD = 0.29, 51% girls and 49% boys) was drawn from a large international dataset, the Organization for Economic Cooperation and Development (OECD) Programme for International Student Assessment (PISA) 2018. Results showed that school-level relational victimization was associated with individual-level relational victimization, and school-level physical victimization was associated with individual-level physical victimization, after controlling for age, gender, and socioeconomic status. Individual-level relational victimization was also uniquely associated with indices of school adjustment (negative affect, positive affect, and fear of failure) over and above physical victimization. While controlling for relational victimization, individual-level physical victimization was associated with indices of school adjustment (positive affect and meaning in life). In further findings, school-level relational and physical victimization were indirectly, but not directly, related to some of students' school adjustment through individual-level relational and physical victimization. These parallel and differential associations suggest the importance of considering the role of relational and physical victimization in school adjustment among Japanese adolescents. [ABSTRACT FROM AUTHOR]

In this article, we describe the package twostep, a bundle of programs to perform analyses of hierarchical data applying the two-step approach. We consider a two-level data setup in which "microlevel" units are nested within "macrolevel" units. One-step models (which can be fit using, for example, mixed) are the most common approach to modeling two-level data. The two-step approach is an alternative in which parameters associated with microlevel and macrolevel predictors are estimated separately for each level. It can be used as an alternative to one-step models if the estimand is a cross-level interaction. We also show how the two-step approach usefully complements one-step approaches by providing exploratory data analysis, descriptive graphs, and regression diagnostics. [ABSTRACT FROM AUTHOR]

Intergroup contact is an effective way to improve intergroup relations, but appropriate evaluative and field research is lacking. We assessed the short- and long-term effectiveness of intergroup contact between refugees and pupils with the workshop "Taking a Closer Look." A total of 388 pupils from 11 Austrian schools were divided into two groups: the contact group attended the workshop including intergroup contact; and the no-contact group, without it. Intergroup contact predicted changes from 1 week before to immediately after the workshop: The pupils' attitudes toward refugees improved in the contact group, whereas they remained unchanged in the no-contact group. Empathy, support for refugee-friendly policies, and willingness to engage in intergroup contact increased in both groups, but significantly stronger in the contact group. Intergroup anxiety decreased and knowledge about refugees increased equally in both groups. One month after the workshop, this knowledge gain remained stable in both groups, but the other effects disappeared. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate the effects of diabetes care on periodontal inflammation. Materials and Methods: This prospective cohort study included 51 Japanese patients with type 2 diabetes who underwent intensive diabetes care including educational hospitalization and regular outpatient treatment for 6 months. Dental prophylaxis without subgingival scaling was provided three times during the observational period. Associations between changes in periodontal parameters and glycaemic control levels were evaluated using multiple regression analysis. Results: Overall, 33 participants (mean age: 58.7 ± 12.9) were followed up for 6 months. At baseline examination, 82% were diagnosed with Stage III or IV periodontitis. Haemoglobin A1c (HbA1c) level changed from 9.6 ± 1.8% at baseline to 7.4 ± 1.3% at 6 months. The ratio of probing pocket depth (PPD) ≥4 mm, bleeding on probing (BOP), full‐mouth plaque control record (PCR), periodontal epithelial surface area (PESA) and periodontal inflamed surface area (PISA) also significantly improved. The reduction in PPD and PESA was significantly associated with changes in both HbA1c and fasting plasma glucose (FPG) levels, and the reduction in PISA was significantly associated with an improvement in FPG after adjusting for smoking, change in body mass index and full‐mouth PCR. Conclusions: This is the first study to report a significant improvement in PPD and BOP after intensive diabetes care and dental prophylaxis without subgingival scaling. Clinical trial registration number: UMIN000040218. [ABSTRACT FROM AUTHOR]

Understanding the relationship between disability and physical activity and whether it differs across local government jurisdictions may aid in the development of placed-based approaches to reducing disability-related inequalities in physical activity. The objectives of this study were to examine the association between disability and physical activity and assess whether this association varied between Australian Local Government Areas. The sample included 13,315 participants aged 18–64 years from the Household Income and Labour Dynamics Australia Survey, 2017. Participants self-reported disability and physical activity. Linear mixed-effects models estimated the association between disability and physical activity. People with disability reported less physical activity per week. We did not find evidence that this association varied across LGAs. Our findings do not add evidence towards local government-based approaches in Australia to reducing physical activity inequalities between people with and without a disability. [ABSTRACT FROM AUTHOR]

The relationship between Information and Communication Technology (ICT) and academic performance is a controversial issue that has attracted increasing attention from administrators, policymakers, and researchers. The relationship between perceived ICT competence and the academic performance of rural students deserves particular attention. Although a small but growing body of research has examined the relationship between perceived ICT competence and student academic performance, few studies have viewed perceived ICT competence as a multilevel construct. This study aimed to fill this gap by examining the relationship between multilevel perceived ICT competence (i.e., student- and school-level perceived ICT competence) and student academic performance using a sample of 5530 students from 156 schools in rural China. Two-level hierarchical linear modeling results indicated that student- and school-level perceived ICT competence could predict academic performance. Furthermore, school-level perceived ICT competence could moderate the relationship between student-level ICT competence and academic outcomes. Specifically, the role of student-level perceived ICT competence showed heterogeneity across schools. Academic performance was strongly correlated with student-level perceived ICT competence in schools with a low level of perceived ICT competence; in contrast, this outcome was not observed in schools with a high level of perceived ICT competence. The findings suggest that administrators and policymakers in China should pay special attention to rural schools where perceived ICT competence is low and consider providing services for students in these schools to promote educational equity. [ABSTRACT FROM AUTHOR]

Aims: The COVID-19 pandemic has had a large impact on the financial situation of higher education students, disproportionately affecting students with a low socioeconomic status (SES). This raises the question of whether economic stressors related to COVID-19 have aggravated existing socioeconomic inequalities in mental health. This study examined the relationship between economic stressors and students' depressive symptoms, and the role of students' SES and countries' socioeconomic conditions. Methods: Data from the COVID-19 International Student Well-being Study was used for multilevel analyses, with depressive symptoms as dependent variable. Three indicators measured SES: educational level of the parents, ability to borrow money from their social network, and struggling with financial resources prior to COVID-19. Results: Students with a low SES had more depressive symptoms, and those not able to borrow money and with parents without higher education were more exposed to a deterioration in their financial situation. Both economic stressors (reduction in working hours and a deterioration of their financial situation) were positively related to depressive symptoms. In addition, the positive relationship between a decrease in working hours and depressive symptoms was stronger in countries with a higher unemployment rate. Conclusions: We observed socioeconomic inequalities in students' mental health, which, in part, can be ascribed to a larger exposure to the economic stressors related to COVID-19 among students' with a low SES. The macroeconomic context also played a role, as the impact of a reduction in working hours on depressive symptoms was stronger in countries with poor economic conditions. [ABSTRACT FROM AUTHOR]

The objective was to investigate the association between the school context and the occurrence of multiple partners among adolescents, considering individual variables (age, gender, Bolsa Família, LGB, early sexual initiation and use of alcohol or drugs in the last sex). Cross-sectional study with multilevel analysis carried out in 2018 with adolescent students from Olinda, Brazil. The variable (multiple partners) was collected based on the 'Youth Risk Behavior Survey' questionnaire. School context variables were time in school (regular school vs. full/semi-full school) and the Social Vulnerability Index of the school district. Of 2,500 participants, 1,044 were analyzed for being sexually active and most had two or more partners (63.89%). Regular school students were more likely (OR 1.47, CI 1.10-1.97) to have multiple sexual partners compared to those in full-day schools/half-day schools. However, no association was found in relation to the SVI of the schools' neighborhoods (OR 1.18, IC 0.82- 1.70). More time spent at school was associated with fewer chances of multiple sexual partners, while studying in schools located in highly vulnerable neighborhoods was not associated with the occurrence of multiple sexual partners among adolescents. [ABSTRACT FROM AUTHOR]

Despite growing interest in the 17 United Nations (UN) sustainable development goals (SDGs), companies still struggle with how to implement them as part of their sustainability policies. Hence, we explore how the SDGs are adopted in supply chain management (SCM) using institutional logic as a theoretical lens. Based on a case study, we analyse 10 interviews conducted with managers and suppliers of a multinational cosmetics company recognised for its sustainability engagement. Our findings show that while the strategic level embraces the SDG framework, supply management processes are exclusively evident at the operational level. This becomes even more salient in the analysis of sustainability and commercial coexisting logics. Although sustainability logic concerns compliance with sustainability‐related regulations and external pressures, commercial logic demonstrates the effective engagement of strategic decisions in favor of profitability. Our results reveal nuances in the existing gap between the SDGs and SCM, illustrated through a typology of coexisting logics at the strategic and operational levels, adding value to the SCM literature. This paper questions the feasibility of implementing the UN SDGs along a supply chain, which opens the door for future research and new practical insights relevant to companies' daily operations. [ABSTRACT FROM AUTHOR]

Globally, there has been little growth in vaccination coverage, with countries in the Horn of Africa having the lowest vaccination rates. This study investigated factors associated with vaccination status among children under five years old in Somaliland. The 2020 Somaliland Demographic and Health Survey surveyed women aged 15–49 years from randomly selected households. This multilevel analysis included 2673 primary caregivers of children under five. Only 34% of children were ever vaccinated. Childhood vaccination coverage was positively associated with high-budget regions, high healthcare facility density, and children older than 23 months. Vaccination coverage was greater for urban and rural residents than for nomadic people. Children whose mothers could read part of one sentence or one complete sentence were more likely to be vaccinated than illiterate mothers. Children whose mothers received antenatal care (ANC) once, two to three times, or four times or more were more likely to be vaccinated than those whose mothers received no ANC. Childhood vaccination coverage in Somaliland is low. Promoting maternal ANC visits and increasing women's literacy may enhance vaccination coverage. Funds should be allocated to areas with low resources, particularly for nomadic people, to boost vaccination uptake. [ABSTRACT FROM AUTHOR]

BackgroundTeenage women's fertility health faces significant challenges from unintended pregnancies and unsafe abortions. Using an emergency contraception within a defined time period could prevent unintended pregnancy and its damaging consequences, like unintended childbirth and unsafe abortion. Despite it being an appropriate contraception, the knowledge of teenage women about emergency contraception is lower among women in developing countries. Therefore, this study aimed to examine the magnitude of emergency contraception knowledge and its associated factors among teenage women in Ethiopia.MethodsData for this study was obtained from the recent Demographic and Health Surveys. A total weighted sample of 3,381 teenage reproductive women were included. The significant associated factors with emergency contraception knowledge among teenage reproductive women were determined by fitting a multilevel mixed-effect binary logistic regression model. Finally, Adjusted Odds Ratio (AOR) with a 95% confidence interval and a P value of less than 0.05 was used to declare statistical significance.ResultsIn Ethiopia, the magnitude of teenage women who knew about emergency contraception was 19.47% (95%CI: 18.17, 20.84). Age 17 years (AOR = 1.76, 95%CI, 1.24, 2.48) and age 19 years (AOR = 2.18, 95%CI, 1.47, 3.22), primary education level (AOR = 2.76, 95%CI, 1.60, 4.76), secondary and above educational level (AOR = 4.70, 95%CI, 2.62, 8.44), being protestant followers (AOR = 0.63, 95%CI, 0.45, 0.87), being muslim followers (AOR = 0.68, 95%CI, 0.49, 0.93), media exposure (AOR = 3.36, 95%CI, 2.59, 4.34), rural residence (AOR = 0.45; 95%CI: 0.22, 0.86), and high community level education (AOR = 140, 95%CI: 1.32, 2.00) were factors significantly associated with knowledge of emergency contraception among teenage women.ConclusionsThis finding concluded that less than one in five teenage women knew about emergency contraception in Ethiopia. The knowledge of emergency contraception among teenage women in Ethiopia was substantially associated with women's age, education level, religion, media exposure, residency and community-level education. Hence, there is a need to implement comprehensive awareness programs and promotion of emergency contraception as a way of curbing cases of unintended pregnancies among teenage women. Government and non-governmental organizations should design targeted educational initiatives and media campaigns to improve emergency contraception knowledge among young teenagers, women with lower educational backgrounds, and rural teenagers.

IntroductionHuman rights violations and violence against women are serious public health issues that have numerous detrimental repercussions on one’s physical, emotional, sexual, and reproductive health. According to studies, women’s perceptions and traits of violence are highly predictive of their likelihood of seeking help against violence. Even though intimate partner violence is a huge challenge nowadays in Africa, there is a low level of help-seeking behavior. Conducting this study at the East African level on help-seeking behavior can provide a clue for policy-makers. Therefore, this study aimed to reveal the prevalence of help-seeking behavior against intimate partner violence and determinant factors among women in East Africa.MethodMultilevel logistic regression analysis was carried out among East Africans using recent demographic and health survey data. A total of 7,387 participants aged 15 to 49 years were included in this study from East African countries. Individual- and community-level variables were considered to determine the associated factors with help-seeking behaviors against intimate partner violence with 95% CI and AOR.ResultsThe prevalence of help-seeking behavior against intimate partner violence among women was 38.07% with 95% CI (36.96%, 39.18%). Husbands drink alcohol [AOR = 1.46: 95% CI (1.33, 1.61)], women who have work [AOR = 1.33: 95% CI (1.19, 1.50)], and women with higher educational status [AOR = 1.36: 95% CI (1.16, 1.59)] were factors associated with help-seeking behavior against intimate partner violence.ConclusionApproximately four out of 10 women were seeking help for intimate partner violence in East Africa. Husbands drinking alcohol, women’s high educational status, and women having occupations were the factors that were associated with help-seeking behaviors against intimate partner violence.

Abstract This study aimed to investigate the association between bullying at school and tooth loss in southern Brazilian adolescents. This population-based cross-sectional study included a representative sample of 15–19-year-old students attending high schools in Santa Maria, southern Brazil. Data on sociodemographic and behavioral variables were collected through questionnaires. Contextual data on bullying at school was provided by educational institutions (bullying episodes in the previous year: ‘no,’ ‘sometimes,’ or ‘often’). Tooth loss was clinically assessed by the M component of the DMFT index, modeled as a discrete variable. Multilevel Poisson regression was used, and rate ratios (RR) and 95% confidence intervals (CI) were estimated. The prevalence of tooth loss was 9.2% (95%CI = 7.5–10.8). Adolescents who attended the schools where bullying events often occurred had 0.39 (95%CI = 0.33–0.45) missing teeth, on average, in contrast to an average of 0.14 (95%CI = 0.08–0.19) among those whose schools did not experience bullying in the previous year. After adjusting for important cofactors, the contextual variable of bullying at school remained significantly associated with the study outcome. Adolescents who attended schools where bullying frequently occurred were 2.49-fold more likely to have an additional missing tooth than those whose school did not experience bullying in the previous year (RR = 2.49, 95%CI = 1.37–4.51, p = 0.003). In conclusion, the frequent bullying episodes at school were associated with more permanent teeth lost due to caries in this population. Hence, improving the school environment may improve the oral health of adolescents.

Cities in Malawi have long been outside the focus of disaster risk reduction. As a result, urban risks remain poorly understood, and urban governments and disaster risk reduction (DRR) practitioners working in cities struggle to adequately support vulnerable urban populations. This is evidenced by recent disasters such as Cyclone Freddy, which devastated the city of Blantyre in 2023, and increasingly common small-scale events in urban areas. This article analyses the Malawian city as a distinct riskscape, shaped by national-level policies of neglect that create an institutional void that DRR practitioners working at the city level struggle to fill. This process is complicated by a multitude of challenges at different levels of governance, especially leaving small-scale events prevalent in urban areas largely unaddressed. This process of risk accumulation is increasingly affecting urban residents. Methodologically, we demonstrate this through a comprehensive policy analysis and by drawing on expert and civil society interviews and questionnaires conducted in Lilongwe City. Contribution: By outlining the interlocking challenges at multiple levels and grounding them in empirical data, we highlight the specificities of urban DRR efforts in Malawi and provide opportunities to improve them.

BackgroundThe majority of maternal deaths were associated with a lack of access to skilled birth attendance. Because childbirth accounts for most maternal deaths, skilled birth attendance is crucial for reducing maternal mortality. The use of skilled birth attendance in Ethiopia is low, and it is crucial to identify factors that determine the use of skilled birth attendance. Hence, this study aimed to assess the spatial distribution, wealth-related inequality, and determinants for skilled birth attendance in Ethiopia.MethodsSecondary data analysis was done with a total weighted sample of 5,251 reproductive-aged women using the 2019 mini EDHS. The concentration index and graph were used to assess wealth-related inequalities. Spatial analysis was done to identify the spatial distribution and multilevel logistic regression analysis was used to identify predictors of skilled birth attendance in Ethiopia. Analysis was done using STATA version 14, ArcGIS, and SaTscan software.ResultsThe prevalence of skilled birth attendance was 50.04% (95% CI: 48.69%, 51.40%) in Ethiopia. Old age, being married, being educated, having television and radio, having ANC visits, being multiparous, having large household sizes, having a rich wealth index, living in rural residence, and living in a high level of community poverty and women's education were significant predictors of skilled birth attendance. Skilled birth attendance was disproportionately concentrated in rich households [C = 0.482; 95% CI: 0.436, 0.528]. High prevalence of unskilled birth attendance was found in Somalia, SNNP, Afar, and southern parts of the Amhara regions. Primary clusters of unskilled birth attendance Somalia and some parts of Oromia region of Ethiopia.ConclusionHalf of the women in Ethiopia did not utilize skilled birth attendants with significant spatial clustering. Age, marital status, educational status, ANC Visit, having television and radio, parity, household size, wealth index, residence, community level poverty, and community level of women's education were significant predictors of skilled birth attendance. Skilled birth attendance was unevenly concentrated in rich households. The regions of Somalia, SNNP, Afar, and southern Amhara were identified as having a high prevalence of using unskilled birth attendance. Public health interventions should target those women at high risk of using unskilled birth attendants.

Communities of color and poor neighborhoods are disproportionately exposed to more air pollution-a pattern known as environmental injustices. Environmental injustices increase susceptibility to negative health outcomes among residents in affected communities. The structural mechanisms distributing environmental injustices in the USA are understudied. Bridging the literatures on the social determinants of health and environmental justice highlights the importance of the environmental conditions for health inequalities and sheds light on the institutional mechanisms driving environmental health inequalities. Employing a critical quantitative methods approach, we use data from an innovative state racism index to argue that systematic racialized inequalities in areas from housing to employment increase outdoor airborne environmental health risks in neighborhoods. Results of a multilevel analysis in over 65,000 census tracts demonstrate that tracts in states with higher levels of state-level Black-white gaps report greater environmental health risk exposure to outdoor air pollution. The state racism index explains four-to-ten percent of county- and state-level variation in carcinogenic risk and noncarcinogenic respiratory system risks from outdoor air toxics. The findings suggest that the disproportional exposure across communities is tied to systematic inequalities in environmental regulation and other structural elements such as housing and incarceration. Structural racism is an environmental justice issue.

Abstract Background Worldwide, recommendations for fruit and vegetable consumption are not met, which can cause chronic diseases. Especially adolescence is an important phase for the development of health behaviours. Therefore, in the Netherlands, the Healthy School program was established to aid schools in promoting healthy lifestyles among their students. We examined to what extent the variation between secondary schools regarding students’ fruit and vegetable consumption could be explained by differences between schools regarding Healthy School certification, general school characteristics, and the school population. Additionally, we examined whether Healthy School certification was related to the outcomes, and whether the association differed for subgroups. Methods We performed a repeated cross-sectional multilevel study. We used data from multiple school years from the national Youth Health Monitor on secondary schools (grades 2 and 4, age ranged from approximately 12 to 18 years) of seven Public Health Services, and added data with regard to Healthy School certification, general school characteristics and school population characteristics. We included two outcomes: the number of days a student consumed fruit and vegetables per week. In total, we analysed data on 168,127 students from 256 secondary schools in the Netherlands. Results Results indicated that 2.87% of the variation in fruit consumption and 5.57% of the variation in vegetable consumption could be attributed to differences at the school-level. Characteristics related to high parental educational attainment, household income, and educational track of the students explained most of the variance between schools. Additionally, we found a small favourable association between Healthy School certification and the number of days secondary school students consumed fruit and vegetables. Conclusions School population characteristics explained more variation between schools than Healthy School certification and general school characteristics, especially indicators of parental socioeconomic status. Nevertheless, Healthy School certification seemed to be slightly related to fruit and vegetable consumption, and might contribute to healthier dietary intake. We found small differences for some subgroups, but future research should focus on the impact in different school contexts, since we were restricted in the characteristics that could be included in this study.

This study tested the effect of variance in service quality ratings on overall scores of users in reviews (7,210 sites, 576,449 reviews) on the well-known hotel accommodation reservation site “Rakuten Travel.” The results revealed that the overall score was lower for a hotel with higher variance in service quality ratings for most functions. This trend was clearer for leisure travelers than for business travelers. An additional survey of general managers of the hotels in the first analysis suggested that practicing total quality management (TQM) in a hotel may reduce the variance in service quality ratings of users.

Abstract Background The prevalence of teenage pregnancy in Colombia is higher than the worldwide average. The identification of socio-geographical disparities might help to prioritize public health interventions. Aim To describe variation in the probability of teenage maternity across geopolitical departments and socio-geographical intersectional strata in Colombia. Methods A cross-sectional study based on live birth certificates in Colombia. Teenage maternity was defined as a woman giving birth aged 19 or younger. Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was applied using multilevel Poisson and logistic regression. Two different approaches were used: (1) intersectional: using strata defined by the combination of health insurance, region, area of residency, and ethnicity as the second level (2) geographical: using geopolitical departments as the second level. Null, partial, and full models were obtained. General contextual effect (GCE) based on the variance partition coefficient (VPC) was considered as the measure of disparity. Proportional change in variance (PCV) was used to identify the contribution of each variable to the between-strata variation and to identify whether this variation, if any, was due to additive or interaction effects. Residuals were used to identify strata with potential higher-order interactions. Results The prevalence of teenage mothers in Colombia was 18.30% (95% CI 18.20–18.40). The highest prevalence was observed in Vichada, 25.65% (95% CI: 23.71–27.78), and in the stratum containing mothers with Subsidized/Unaffiliated healthcare insurance, Mestizo, Rural area in the Caribbean region, 29.08% (95% CI 28.55–29.61). The VPC from the null model was 1.70% and 9.16% using the geographical and socio-geographical intersectional approaches, respectively. The higher PCV for the intersectional model was attributed to health insurance. Positive and negative interactions of effects were observed. Conclusion Disparities were observed between intersectional socio-geographical strata but not between geo-political departments. Our results indicate that if resources for prevention are limited, using an intersectional socio-geographical approach would be more effective than focusing on geopolitical departments especially when focusing resources on those groups which show the highest prevalence. MAIHDA could potentially be applied to many other health outcomes where resource decisions must be made.

Abstract Consuming foods high in iron benefits metabolic processes as well as the development of the neonatal and fetal brain. Despite the significance of eating foods high in iron for public health, Ethiopian practices are still limited when compared to the World Health Organization's (WHO) assessment of its consumption of such foods. This study used the Ethiopia Demographic and Health Survey (EDHS) to evaluate the consumption of iron-rich foods, regional clustering, and related characteristics among children aged 6–23 months. The information was taken from the typical EDHS 2019 dataset, which included a weighted sample of 1572 young children aged 6–23 months old in total. Utilizing Kuldorff's SaTScan version 9.6 software, spatial scan statistics were produced. Software from ArcGIS 10.8 was used to display the regional distribution of inadequate consumption of foods high in iron. Utilizing multilevel or mixed effects logistic regression analysis, the associated determinants for a healthy diet rich in foods containing iron were found. In the final model, a P-value of

Abstract Purpose According to the 4th and 5th rounds of National Family Health Survey (NFHS), there is high prevalence of hysterectomies in the three states of Andhra Pradesh Telangana and Bihar. The three said states have more than double the number of hysterectomies taking place than the national average. Our purpose is to analyse whether these rates are increasing, decreasing or have stabilized and their reasons thereof. Such an analyses will help the policy makers in recommending good clinical practices within their states. Material and methods We used data from NFHS-4 (2015-16) and NFHS-5 (2019-2021) rounds. We calculated the differences in predicted probabilities for various factors, performed a Fairlie Decomposition analyses to quantify the positive and negative contributors in the prevalence of hysterectomy across the three states over two time points, and assessed the association of various socio-demographic characteristics to hysterectomy through a multilevel logistic regression model. Results and conclusion The results show that out of a total of 80,976 eligible respondents from the states under study, 5826 respondents self-reported that they had a hysterectomy done. It was found that older age, living in rural areas, belonging to other backward classes and higher wealth quintile, and higher parity positively contributed to the increased prevalence of hysterectomies in the three states. Higher educational attainment and previous use of family planning methods acted as protective factors. Characteristics at the household level had the highest intra-class correlation value in the prevalence of hysterectomy among women, followed by the Primary Sampling Unit and District levels, indicating high clustering in the prevalence of hysterectomy at the household level in all three states. Heavy menstrual bleeding/pain was the leading cause of hysterectomies in all three states, followed by fibroids/cysts in Andhra Pradesh and Telangana and Uterine disorder/ prolapse in Bihar. Over 80% of hysterectomies took place in the private hospitals. Recommendations The study recommends better, more efficient and accountable hysterectomy surveillance to ensure more sustainable woman’s reproductive health services in India. Government should adopt and implement standard regulatory guidelines to prevent provider-driven avoidable hysterectomies. Moreover, we recommend informing primary care professionals about the long-term health effects of hysterectomy and promoting alternate therapies for treating uterine fibroids and heavy bleeding.

Abstract Background Despite the World Health Organization’s firm recommendation to start breastfeeding during the first hour after delivery, nearly 54% of children in low- and middle-income countries are unable to initiate breastfeeding within the recommended time frame. Understanding the initiation of breastfeeding is essential for optimal child health and maternal well-being. Methods This study was conducted using the recent Ethiopian Demographic and Health Survey (EDHS) data (2019) on a weighted sample of 1982 Ethiopian mothers of children aged under 24 months. The data extraction was conducted between August 1 and 30, 2023. Delayed’ initiation of breastfeeding is defined as failure to initiate breastfeeding within one hour after birth. STATA version 17 was used for non-spatial analysis. ArcGIS Pro and Sat Scan version 9.6 were used to map the visual presentation of delayed breastfeeding initiation. Global Moran’s I was computed to determine whether delayed breastfeeding initiation is randomly distributed, clustered, or dispersed. Getis-Ord Gi* Spatial Statistics was done to identify significant spatial clusters of cold and hot spot areas. Multilevel mixed-effect logistic regression analysis was computed to identify determinants of delayed breastfeeding initiation. Results The prevalence of delayed breastfeeding initiation is 26.4% (95% CI 24.4, 28.3). Significant clustering of delayed initiation of breastfeeding practice was found in the Somali region. Less clustering was identified in Northern Amhara, Addis Ababa and Dire Dawa. Being a young mother (15–24 years) (AOR 1.66; 95% CI 1.06, 2.62), no antenatal care (AOR 1.45; 95% CI 1.04, 2.02), cesarean section (AOR 4.79; 95% CI 3.19, 7.21) and home birth (AOR 1.53; 95% CI 1.14, 2.06) were found to be determinants of delayed initiation of breastfeeding. Conclusions In Ethiopia, delayed breastfeeding initiation is distributed non-randomly. Significant hotspot areas were identified in the eastern part of Ethiopia. Thus, deploying additional resources in high hotspot regions is recommended. Programs should focus on promoting health facility birth and increasing antenatal care visits. Further emphasis should be considered on supporting young mothers and those giving birth via cesarean section to improve timely breastfeeding initiation.

Teenage pregnancy remains a critical public health issue in developing countries, significantly impacting maternal health. In Kenya, despite an expected decrease in teenage pregnancy rates from 18% in 2014 to 15% in 2022, evidence on its prevalence and associated factors is still limited. This study utilized data from the latest Kenya Demographic and Health Survey, analysing 6,390 participants through multilevel binary logistic regression. The findings revealed a 15.3% prevalence (95%CI: 14.4, 16.2%) and identified key factors linked to teenage pregnancy, including being aged 18–19, higher education, contraceptive use, unemployment, wealth status, media exposure, and a higher proportion of uneducated individuals. The study underscores the urgent need for strategic investment in policy development and evaluation to enhance adolescent sexual and reproductive health. Targeted interventions should prioritize economically disadvantaged households, focusing on maternal education and empowerment to reduce teenage pregnancies by 2030.

Previous research on customer loyalty primarily viewed it within the framework of constructs at the individual level of analysis. Consequently, prior research has ignored service recovery performance and customer loyalty nested within the branch-level studies of retail banks. However, this multilevel analysis examined how the service recovery system influences customer-level outcomes. Multilevel analysis determined the relationship between the Level 2 and Level 1 constructs. A sample of 1514 responses was drawn from Indian branch heads, frontline employees, and customers of retail banks. This study used a multilevel approach to understand the macro- and micro-level dynamics of service recovery in retail banking. These findings emphasize the importance of effective service recovery systems, standardized definitions, and standardized measurements. This approach allows for a comprehensive examination of the impact of the service recovery system on service recovery performance, recovery satisfaction, and customer service loyalty by considering the nested structure of the data and the influence of higher-level variables on lower-level variables. This study calls for retail banks to invest in well-managed service recovery, recognize and reward employees for exceptional performance, and continuously monitor customer complaints to identify areas for improvement.

Background: Worldwide, recommendations for fruit and vegetable consumption are not met, which can cause chronic diseases. Especially adolescence is an important phase for the development of health behaviours. Therefore, in the Netherlands, the Healthy School program was established to aid schools in promoting healthy lifestyles among their students. We examined to what extent the variation between secondary schools regarding students' fruit and vegetable consumption could be explained by differences between schools regarding Healthy School certification, general school characteristics, and the school population. Additionally, we examined whether Healthy School certification was related to the outcomes, and whether the association differed for subgroups. Methods: We performed a repeated cross-sectional multilevel study. We used data from multiple school years from the national Youth Health Monitor on secondary schools (grades 2 and 4, age ranged from approximately 12 to 18 years) of seven Public Health Services, and added data with regard to Healthy School certification, general school characteristics and school population characteristics. We included two outcomes: the number of days a student consumed fruit and vegetables per week. In total, we analysed data on 168,127 students from 256 secondary schools in the Netherlands. Results: Results indicated that 2.87% of the variation in fruit consumption and 5.57% of the variation in vegetable consumption could be attributed to differences at the school-level. Characteristics related to high parental educational attainment, household income, and educational track of the students explained most of the variance between schools. Additionally, we found a small favourable association between Healthy School certification and the number of days secondary school students consumed fruit and vegetables. Conclusions: School population characteristics explained more variation between schools than Healthy School certification and general school characteristics, especially indicators of parental socioeconomic status. Nevertheless, Healthy School certification seemed to be slightly related to fruit and vegetable consumption, and might contribute to healthier dietary intake. We found small differences for some subgroups, but future research should focus on the impact in different school contexts, since we were restricted in the characteristics that could be included in this study. [ABSTRACT FROM AUTHOR]

While cellular metabolism was proposed to be a driving factor of the activation and differentiation of B cells and the function of the resulting antibody-secreting cells (ASCs), the study of correlations between cellular metabolism and functionalities has been difficult due to the absence of technologies enabling the parallel measurement. Herein, we performed single-cell transcriptomics and introduced a direct concurrent functional and metabolic flux quantitation of individual murine B cells. Our transcriptomic data identified lactate metabolism as dynamic in ASCs, but antibody secretion did not correlate with lactate secretion rates (LSRs). Instead, our study of all splenic B cells during an immune response linked increased lactate metabolism with acidic intracellular pH and the upregulation of apoptosis. T cell-dependent responses increased LSRs, and added TLR4 agonists affected the magnitude and boosted LSRhigh B cells in vivo, while resulting in only a few immunoglobulin-G secreting cells (IgG-SCs). Therefore, our observations indicated that LSRhigh cells were not differentiating into IgG-SCs, and were rather removed due to apoptosis. [ABSTRACT FROM AUTHOR]

The aims of this study were to describe the national distribution of depressive symptoms in Chinese children and adolescents, to examine the determinants of depressive symptoms at individual, school and province levels and to assess the gender and age differences in the effect of school factors on depressive symptoms. This was a national cross-sectional study. A school-based online survey was conducted in mainland China from between December 1, 2021, and January 1, 2022. A total of 398,520 eligible participants were included in the analysis. School-level data were drawn from students, headteachers and Baidu Maps, and province-level data were obtained from the national human development report. The Patient Health Questionnaire-2 was used to measure depressive symptoms. Areas with the highest mean scores for depressive symptoms were in the northeastern, inner central and southwestern regions of China. At the individual level, younger age, male sex, being an only child, Han ethnicity, lower body mass index, more days of exercise, less drinking and smoking behaviours, higher subjective family socio-economic status (SES) and popularity in school were related to fewer depressive symptoms; however, objective family SES and maternal education were not related to fewer depressive symptoms. The school-level variables of public status, psychological activities and psychological courses and province-level variable of higher Human Development Index were associated with fewer depressive symptoms. The effect of psychological courses and activities on depressive symptoms was greater in females. The results showed multilevel factors related to depressive symptoms and emphasised the importance of implementing school-based psychological activities to ameliorate depressive symptoms in Chinese children and adolescents across age and gender. [ABSTRACT FROM AUTHOR]