Educational level and characteristics of invasive breast cancer: findings from a French prospective cohort.

PURPOSE: Breast cancer (BC) characteristics are known to influence patients survival. Social differences have been reported by previous studies for those characteristics but questions persist because of inconsistent conclusions. We aimed to investigate the impact of education on BC stage, grade, and hormone receptor (HR) status, while adjusting for potential confounders including a broad set of health behaviors, anthropometric measures, and reproductive factors. METHODS: In the French E3N cohort, 5236 women developed a primary invasive BC for which there was available information on stage, grade, and HR status. No multivariate analyses was performed for BC stage based on the lack of association in bivariate analyses. Odds ratios and confidence intervals were estimated using multinomial logistic regression models for BC grade or binomial logistic regression models for HR status of BC. RESULTS: Women with a lower education were diagnosed with higher grade BC compared to women with a higher education (1.32 [1.12; 1.57]). This association was slightly attenuated after adjustment for covariates independently and more strongly affected in the fully adjusted model (1.20 [0.99; 1.45]). A significant association was observed between lower education and HR- status of BC (1.20 [1.02; 1.42]) attenuated after adjustment for age at first childbirth (1.12 [0.95; 1.33]). CONCLUSION: In this cohort, education was associated with BC grade and HR status but not stage at diagnosis. The link between education and BC grade was not entirely explained by the different adjustments. A specific mechanism could be at play and deserves further investigations.

Educational status affects prognosis of patients with heart failure with reduced ejection fraction: A post-hoc analysis from the WARCEF trial.

AIMS: The influence of social determinants of health (SDOH) on the prognosis of Heart Failure and reduced Ejection Fraction (HFrEF) is increasingly reported. We aim to evaluate the contribution of educational status on outcomes in patients with HFrEF. METHODS: We used data from the WARCEF trial, which randomized HFrEF patients with sinus rhythm to receive Warfarin or Aspirin; educational status of patients enrolled was collected at baseline. We defined three levels of education: low, medium and high level, according to the highest qualification achieved or highest school grade attended. We analysed the impact of the educational status on the risk of the primary composite outcome of all-cause death, ischemic stroke (IS) and intracerebral haemorrhage (ICH); components of the primary outcome were also analysed as secondary outcomes. RESULTS: 2295 patients were included in this analysis; of these, 992 (43.2%) had a low educational level, 947 (41.3%) had a medium education level and the remaining 356 (15.5%) showed a high educational level. Compared to patients with high educational level, those with low educational status showed a high risk of the primary composite outcome (adjusted hazard ratio [aHR]: 1.31, 95% confidence intervals [CI] 1.02-1.69); a non-statistically significant association was observed in those with medium educational level (aHR: 1.20, 95%CI: .93-1.55). Similar results were observed for all-cause death, while no statistically significant differences were observed for IS or ICH. CONCLUSION: Compared to patients with high educational levels, those with low educational status had worse prognosis. SDOH should be considered in patients with HFrEF. CLINICAL TRIAL REGISTRATION: NCT00041938.

Health-related quality of life of Indonesian children with hemophilia.

INTRODUCTION: Measuring health-related quality of life (HRQoL) in haemophilia patients provides a comprehensive patient's functional and the impact of the disease and its treatment. AIM: This study aimed to assess the HRQoL of haemophilia children and related factors. METHODS: We conducted a cross-sectional study from 6 April 2019 to 29 April 2019. We recruited children aged 8-16 years old who were members of the Yogyakarta Province Branch, Indonesian Haemophilia Society. Children filled in the Indonesian Haemo-QoL short-version questionnaire that consists of nine dimensions, and the score ranges from 0 to 100, in which a higher score shows a higher impartment. RESULTS: Forty-four children participated in this study. The mean age was 11.99 + 2.49. The median age of the first bleeding episode was 5 years, and the median frequency of spontaneous bleeding during the previous year was 13.5. All children received antihemophilic factor (AHF) on-demand; most (81.8%) received AHF in the advanced symptoms. The mean total score of HRQoL was 42.7 ± 15.5, with the highest impairment in the family dimension, with a mean score of 68.0 ± 22.3. The severity of haemophilia was significantly correlated with the total score of HRQoL and dimensions of physical health, feeling, view, and family (effect size ranges from 0.30 to 0.42). The frequency of bleeding was significantly related to the total score of HRQoL and the feeling dimension (effect size of 0.47 and 0.34). CONCLUSION: The HRQoL of our study was lower than in countries where AHF prophylactic is provided. More severe haemophilia and more frequent bleeding significantly lower HRQoL.

Educational level and gender are associated with emotional well-being in a cohort of Dutch dialysis patients.

BACKGROUND: Patients undergoing dialysis have an impaired health-related quality of life (HRQOL). There are conflicting data from small series on whether patient-related factors such as educational level have an impact on experienced HRQOL. The aim of this study was to investigate the association between educational level and HRQOL in dialysis patients. METHODS: In a single-center retrospective cross-sectional study HRQOL was measured using the Kidney Disease Quality of Life Short Form-36 (KDQOL-SF36) in prevalent chronic dialysis patients. Educational level was categorized into low, intermediate and high subgroups. Univariate and multivariate regression analyses were performed to assess the effects of age, gender, ethnicity, and dialysis vintage on the association between HRQOL and educational level. RESULTS: One hundred twenty-nine chronic dialysis patients were included. Patients with an intermediate educational level had significantly higher odds of a higher emotional well-being than patients with a low educational level 4.37 (1.-89-10.13). A similar trend was found for a high educational level (OR 4.13 (1.04-16.42), p = 0.044) The odds for women compared to men were 2.83 (1.32-6.06) for better general health and 2.59 (1.15-5,84) for emotional well-being. There was no interaction between gender and educational level for both subdomains. Each year of increasing age significantly decreased physical functioning (OR 0.94 (0.91-0.97)). CONCLUSIONS: Educational level and sex were associated with emotional well-being, since patients with intermediate and high educational level and females had better emotional well-being in comparison to patients with low educational level and males. Physical functioning decreased with increasing age.

Socio-familial environment influence on cognitive and language development in very preterm children.

BACKGROUND: Preterm children are at increased risk of cognitive and language delay compared with term-born children. While many perinatal factors associated with prematurity are well established, there is limited research concerning the influence of the socio-familial environment on the development of preterm children. This study aims to assess the relative impact of perinatal and socio-familial risk factors on cognitive and language development at 2 years corrected age (CA). METHOD: This retrospective cross-sectional study included preterm infants with a gestational age <32 weeks and/or a birth weight <1500 g, who underwent neurodevelopmental assessment at 2 years CA. Cognitive and language scores were assessed using the Bayley Scales of Infant-Toddler Development, third edition. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated using a multivariable model to examine the relationship between developmental delays and perinatal and socio-familial factors. RESULT: The prevalence of language delay was negatively associated with daycare attendance (aOR: 0.25, 95% CI: 0.07-0.85, p < 0.05) and high maternal educational levels (aOR: 0.24, 95% CI: 0.05-0.93, p < 0.05) and positively associated with bilingual environments (aOR: 5.62, 95% CI: 1.46-24.3, p < 0.05). Perinatal and postnatal risk factors did not show a significant impact on cognitive or language development. CONCLUSION: The development of language appears to be more influenced by the socio-familial environment than by early perinatal and postnatal factors associated with prematurity. These findings highlight the importance of considering socio-familial factors in the early identification and intervention of language delay among preterm children.

Impact of health literacy and social support on medication adherence in patients with hypertension: a cross-sectional community-based study.

BACKGROUND: Previous studies have examined the associations of health literacy and social support with medication adherence among patients with hypertension. However, limited evidence exists regarding the mechanisms underlying the relationship between these factors and medication adherence. PURPOSE: To explore the prevalence of medication adherence and its determinants in patients with hypertension in Shanghai. METHODS: A community-based cross-sectional study was conducted among 1697 participants with hypertension. We collected sociodemographic and clinical characteristics as well as data regarding health literacy, social support, and medication adherence using questionnaires. We examined interactions among the factors using a structural equation model. RESULTS: The participants included 654 (38.54%) patients with a low degree of medication adherence and 1043 (61.46%) patients with a medium/high degree of adherence. Social support directly influenced adherence (ß = 0.165, P < 0.001) and indirectly influenced adherence through health literacy (ß = 0.087, P < 0.001). Health literacy directly influenced adherence (ß = 0.291, P < 0.001). Education indirectly affected adherence through both social support (ß = 0.048, P < 0.001) and health literacy (ß = 0.080, P < 0.001). Moreover, there was a sequential mediating effect of social support and health literacy on the association between education and adherence (ß = 0.025, P < 0.001). After controlling for age and marital status, similar results were also obtained, indicating a good model fit. CONCLUSIONS: The degree of medication adherence among hypertensive patients needs to improve. Health literacy and social support had both direct and indirect effects on adherence, and thus, these factors should be considered as tools to improve adherence.

Does our cognitive empathy diminish with age? The moderator role of educational level.

INTRODUCTION: The literature has demonstrated how the relationship between cognitive or emotional intelligence and age exhibits an inverted-U-shape and that this decline can be mitigated by an individual's cognitive reserve (CR). Rather less is known, however, about the pattern of changes in cognitive empathy or the ability to recognize the thoughts or feelings of others. OBJECTIVES: The aim of the present study was firstly to analyze the effect of age, gender, and CR (measured through educational level), on the capacity to show cognitive empathy. Secondly, we aimed to evaluate what type of relationship-linear or quadratic-exists between age and cognitive empathy. We finally aimed to analyze the moderator role of educational level on the relationship between age and cognitive empathy. PARTICIPANTS: Totally, 902 Spanish adults aged between 18 and 79 years (M = 43.53, SD = 11.86; 57% women). MEASUREMENTS: Participants were asked to indicate their educational level (primary, high school, or college education) and their cognitive empathy was assessed using the Eyes test. RESULTS: Women scored higher than men on cognitive empathy. Participants with a college education had higher scores on cognitive empathy than those with a lower educational level. Additionally, the relationship between age and cognitive empathy fit an inverted-U-shaped curve, consistent with the data found for cognitive and emotional intelligence. Finally, the age-related decrease in cognitive empathy appeared to be mitigated by a higher educational level, but only in those individuals aged 35 years and above. Limitations and clinical implications are discussed.

Socioeconomic inequalities in diabetes prevalence: the case of Egypt between 2008 and 2015.

BACKGROUND: There is a steady increase in diabetes prevalence globally and many studies imply that high socioeconomic status (SES) is inversely related to diabetes prevalence. However, there is scarcity in literature from countries like Egypt regarding this topic. METHODS: This study aims to investigate prevalence of diabetes in Egypt between 2008 and 2015, and the effect of SES. Diabetes prevalence -based on self-reports of past diagnosis- was measured using two datasets Egypt DHS 2008 (10,917 participants) and EHIS 2015 (16,485 participants). Logistic regression and odds ratios (ORs) with 95% confidence intervals (CIs) were applied for diabetes controlling for age, gender, educational level, employment status and place of residence. Extend of difference in diabetes prevalence between the two time points was measured by combining the two datasets using the EDHS 2008 as reference. RESULTS: Diabetes prevalence was higher in 2015 (4.83%) compared to 2008 (3.48%). It was more in women at both time points (4.08% and 5.16% in 2008 and 2015 respectively) compared to men (2.80% and 4.43% in 2008 and 2015 respectively). Older age and living in urban areas were positively related to diabetes prevalence at both time points. Men had a significant higher chance of developing diabetes in 2015 (OR = 1.45, p-value = 0.001). Men with higher education had higher chance of developing diabetes (OR = 1.76), in contrast to women (OR = 0.59). Employment decreased the chance of developing diabetes for men (OR = .72), but had minimal effect on women (OR = 1.06). CONCLUSION: Diabetes prevalence in Egypt has increased between the years 2008 and 2015 and evident social inequalities were found. Women had more diabetes than men and were more affected with low SES. Unlike women, highly educated men had higher chance of developing diabetes in 2015 compared to 2008. This might be attributed to behavioral and sociocultural factors.

Socioeconomic inequalities in diabetes prevalence: the case of South Africa between 2003 and 2016.

BACKGROUND: Diabetes is a growing epidemic worldwide and the effect of socioeconomic status (SES) is frequently acknowledged in the literature. This study aims to compare the effect of SES on diabetes prevalence in South Africa between 2003 and 2016. In addition, vulnerable groups regarding diabetes development in 2016 will be identified. METHODS: Using DHS data there were 8,006 participants (59.19% women) in 2003 and 10,292 participants (59.42% women) in 2016. Logistic regression and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for diabetes by age, gender, educational level and place of residence. To identify vulnerable groups with high risk of developing diabetes in 2016, the method of p-value based regression tree analysis was applied using "wealth index" and "weight perception" as additional variables. RESULTS: There was an increase in diabetes prevalence from 3.86% in 2003 to 4.46% in 2016. Women had more risk of developing diabetes at both time points (27% in 2003 and 24% in 2016 more risk). Increase in age and living in urban areas were associated with more risk of developing diabetes at both time points. There was no specific pattern regarding risk of developing diabetes and educational level in case of women. However, men who completed secondary school or had a higher diploma or above had more risk of developing diabetes in 2016 (OR = 2.24 and 4.67 respectively). Vulnerable groups who have higher risk of developing diabetes in 2016 were participants aged "60 years or older" with a wealth index of "rich" or "richer", followed by participants from the same age group who were "poor" or "poorer" and participants aged "40-59 years" with a wealth index of "rich" or "richer". Subsequently were participants from the age group "15-39 years" with a weight perception of "overweight" or "obese". CONCLUSION: Diabetes prevalence increased in South Africa between 2003 and 2016. Main risk factors were age, gender and living in urban areas. Men with high educational level were more at risk of developing diabetes in 2016. Vulnerable groups in 2016 were participants 40 years and older, particularly with high SES. This was followed by younger participants who were obese or overweight.

Motives for leisure-time physical activity participation: an analysis of their prevalence, consistency and associations with activity type and social background.

BACKGROUND: Studies argue that knowledge about motives for physical activity participation can inform activities, initiatives and interventions to promote physical activity. However, most of these studies are based on small sample sizes and only include participants within a few selected types of PA. Further, they have not examined the consistency of individuals' motives across different activity types. As a result, this article examines RQ1: the most prevalent motives, RQ2: the association of motives with activity type and social background characteristics, and RQ3: the consistency of motives across different activity types. METHODS: We utilised data from a survey of physical activity participation among 163,000 adult Danes (aged 15 + years). In the survey, the participants were asked about their participation in thirteen activity types and about their motives for practising the activity types they reported to do at least weekly. The motive items were operationalised based on the eight dimensions in the Physical Activity and Leisure Motivation Scale (PALMS). We conducted analyses of mean values and standard deviations as well as multilevel regression analyses. RESULTS: We identified large differences in the importance of different motives for physical activity participation. The three most important motives were psychological condition (M = 4.54), physical condition (M = 4.48) and enjoyment (M = 4.36). We also found significant associations between motives and activity types in particular, but also between motives and social background characteristics (gender, age and educational level). For instance, we found that compared to running, physical condition was a much less important motive in outdoor activities (b = -3.01), activities on water (b = -2.44) and street sports (b = -2.38). Finally, our analysis showed how individuals' motives are not consistent across different activity types. CONCLUSIONS: Our study contributes to the literature on motives for physical activity participation by using a large sample of individuals and by differentiating motives according to a wide range of activity types. The results underline the need to study motives in relation to activity types, as there are large differences in the prevalence of different motives. Our findings suggest that motives are not consistent across activity types, but rather they develop in an interplay between the individual and the activity type practised.

Monitoring and control processes in mock witnesses in under-represented non-WEIRD samples with high or low educational level.

A popular model proposes that metamemory is based on two processes, monitoring and control. The first examines memories and evaluates their quality and the second uses that information to decide on the most appropriate course of action. Monitoring and control processes have been studied mostly with university students, which raises the question of how well do they work in groups of people from under-represented samples such as people with a low educational level. In this research, we tested the monitoring and control processes of three groups of participants from a non-WEIRD (Western, Educated, Industrialized, Rich and Democratic) country (Colombia). Two groups of adults (aged 30-55 years) living in urban or rural areas and with a low educational level and a group of Colombian university students watched a bank robbery video and answered cued recall questions. To measure monitoring ability, participants rated their confidence that they had produced the correct answer, and to measure control they indicated whether they preferred to report or withhold the response were they in a trial. Results showed that the three groups had a functional ability to monitor their memories and control their behaviour, and that university students had better memory and metamemory than the two low education groups. The results support the concept that the basic metamemory processes of monitoring and control are functional in different groups of individuals, but the differences between groups highlight the need to test the generalizability of cognitive processes and phenomena across individuals.

Socioeconomic outcomes beyond 30 years of age in a cohort born with very low birth weight.

AIM: As survival of infants born prematurely has increased dramatically, questions on long-term consequences have emerged. Our aim was to investigate long-term effects of very low birth weight on socioeconomic outcomes. METHODS: One hundred and fifty very low birth weight infants (VLBW) born from 1980 to 1982 at Rigshospitalet, Denmark, who had previously been followed up at age 2, 4 and 18 years, were compared to cohorts of low birth weight, normal birth weight (NBW) and a national population-based reference cohort. From the Danish national registers we obtained data regarding educational level, financial independence and living arrangements. In addition, we used the previously published results from the three cohorts. RESULTS: The VLBW cohort had lower intelligence quotient and higher risk of significant school difficulties evaluated at age 4 and 18 years. When compared to the NBW cohort, at 30-36 years of age the VLBW cohort tended to have lower educational level, OR 1.7, 95% CI 0.8-3.9, were not financially independent OR 1.5, 95% CI 0.6-3.7, lived alone OR 2.0, 95% CI 1.0-3.8 and had higher rates of the combination of all three outcomes, OR 3.2, 95% CI 0.7-15.8. CONCLUSIONS: We found trends towards poor socioeconomic outcomes in young adults born with VLBW. The relative disadvantages appeared smaller than that in childhood.

The role of school education in time-dependent changes of cognitive abilities in cohorts from midlife to old age.

OBJECTIVES: It is examined whether older adults' cognitive ability in terms of delayed recall and verbal fluency is improving over time, whether this occurs over all educational levels and both sexes, and whether these changes are due to increasing proportions of individuals with higher education. METHODS: Analyses are based on the German samples of the Survey on Health, Ageing and Retirement in Europe (waves 2004 and 2013). RESULTS: Achievement levels increased over time and in all age groups. Improvements over educational levels occurred in parallel, differences between educational levels in the earlier survey were later reproduced at higher levels. Increasing proportions of individuals with higher education did not explain improvements of cognitive ability. No sex differences emerged. CONCLUSION: Improved cognitive abilities could not be explained by upward shifts of educational levels. Improvements in higher age groups may foster improved health status and prolonged self-determined life in the older population.

Socio-economic inequalities in health among older adults in China.

OBJECTIVES: This study aimed to explore socio-economic inequalities in the health status of older people in China using the most recent data available. STUDY DESIGN: This was a cross-sectional study. METHODS: Data for this study were obtained from the 2018 China Health and Retirement Longitudinal Study, which included 9831 subjects aged 60 years and older. We assessed differences in the prevalence of self-reported health, functional limitations, and chronic conditions by education level and household income level, and then estimated the Slope of Inequality Index (SII) and the Relative Inequality Index (RII) - indexes of the relative magnitude of socio-economic inequalities in health. RESULTS: We found inequalities in all dimensions of health (self-assessed health status, reported chronic conditions, and physical functional limitations) at the household income level. Physical functional limitations, particularly the ability to perform instrumental activities of daily living, produced greater inequality than other domains, with an adjusted SII of 0.495 (95% CI, 0.467-0.524) and an adjusted RII of 2.129 (95% CI, 1.604-2.653). ADL limitations (adjusted SII, 0.524, 95% CI, 0.473-0.575, adjusted RII, 1.527, 95% CI, 1.027-2.027) and self-measured health (adjusted SII, 0.523, 95% CI, 0.258-0.789, adjusted RII, 1.531, 95% CI, 0.551-2.512) were also clearly different. Inequalities were also found across all health domains in terms of educational attainment. Consistent with inequalities in household income, inequalities were greatest for limitations in the ability to perform instrumental activities of daily living (adjusted SII, 0.581, 95% CI, 0.424-0.739, adjusted RII, 3.699, 95% CI, 3.642-3.757). Relative inequalities in limitations in activities of daily living (adjusted SII, 0.676, 95% CI, 0.560-0.792, adjusted RII, 2.587, 95% CI, 2.392-2.784) and self-rated health (poor/very poor) (adjusted SII, 0.647, 95% CI, 0.617-0.677, adjusted RII, 2.406, 95% CI, 2.224-2.587) were also higher. CONCLUSION: Our study shows significant socio-economic differences in the areas of self-rated health, functional limitations, and reported chronic diseases, particularly in the area of IADL limitations. These inequalities need to be explicitly addressed and vulnerable subgroups should be targeted to reduce the socio-economic disparities.

Lower educational level remains associated with lower body height among Austrian conscripts born from 1961 through 2002.

Growth patterns and final body height are influenced by genetic and socio-environmental factors. A major impact of education on growth has been documented. Body height increases with an increasing educational level.The present study focuses on the association patterns between body height and educational level among 1,734,569 Austrian male conscripts aged 17 to <19 born between 1961 and 2002. Four levels of education were classified to examine their association with body height. Over 42 years, the percentage of conscripts at the lowest educational level decreased dramatically from 37.5% to 1.7%. All educational classes showed increasing body heights over time. Despite a marked improvement in the living standard, body heights at different educational levels did not converge. In Austria, educational and social advancement was associated with higher population body heights. Young men at the lowest educational level, however, remain shorter and their body height gap to the highest educational level has widened.

Children oral health and parents education status: a cross sectional study.

INTRODUCTION: Oral diseases are common and affect millions of people worldwide. They can range from mild and easily treatable conditions to more severe and serious diseases. Proper oral hygiene and regular dental monitoring are essential for maintaining good oral health. When it comes to children's health and well-being, parents' education level plays a critical role. Research has shown that parents' higher educational attainment is associated with better health outcomes for their children. Our aim is to evaluate whether parents' education level and employment influence children oral health and its impact on the family. METHODS: We enrolled consecutively healthy subjects aged between 0-16 and their parents at the Dental Clinic of the University of Campania "L. Vanvitelli". The Italian version of the ECOHIS (I-ECOHIS) was administered to parents of the enrolled subjects referred to the Dental Clinic of the University of Campania "L. Vanvitelli". Linear regression models, adjusted for age and sex, were used to explore the association between parents' employment or education level and the ECOHIS scores. Statistical significance was accepted when p value < 0.05. RESULTS: We found a significative association of a higher I-ECOHIS total score (coeff. 4.04244; CI 95%: 1.530855-6.554026; p = 0,002) and higher I-ECOHIS children section score (coeff. 3.2794; CI 95%: 1.29002-5.268; P = 0,002) and the father unemployed status. We also found that a higher education level of the father was associated with a lower ECOHIS total score (coeff. -1.388; IC 95%: -2.562115--0.214 p = 0.021) and a higher education level of the mother was associated with a lower ECOHIS in children section (coeff. -0.972; IC95%: -1.909356-0.034; p = 0.042). CONCLUSIONS: Father unemployed status and a lower educational level for both parents may negatively affect oral health status.

The impact of the COVID-19 pandemic on the use of Emergency Departments in Italy.

Background: During 2020, COVID-19 had a diversified distribution in Italy, the first nation in Europe to experience the outbreak of the epidemic. This was linked to geographical differences in population density and distribution of healthcare facilities, including Emergency Departments (EDs). This study aims to assess the impact of the pandemic on ED utilization in 2020 across different subpopulations and geographical locations in Italy. Methods: We used anonymized data from a survey conducted by the Italian National Institute of Statistics on 25,000 families to analyze the yearly rate of people who used EDs from 2015 to 2020. The rate of persons who accessed ED services in 2020 per 1,000 population was compared with those of the previous non-pandemic years. Results: The number of people accessing EDs in 2020 was 32.3% lower, although this reduction was not uniform across the 21 regions / autonomous provinces. People aged 0-14 years experienced the highest reduction in ED visits. In 2020, low educational level people exhibited a steeper reduction in the use of EDs. Conclusions: This study shows a significant drop in EDs use especially by children; the population section mostly affected by the effects of the pandemic. This study also confirms that education and socio-economic status are important determinants of ED use. The heterogeneous reduction in ED use across the regions of Italy highlights the need to further investigate the impact of this pattern on the health of the population, as well as to define adequate preparedness strategies to face future emergencies.

The Effect of Web-Based Biology Learning Environment on Academic Performance: A Meta-analysis Study.

The purpose of this study was to investigate the effectiveness of web-based biology learning environment in improving academic performance via a meta-analysis. In looking for the studies on web-based biology learning environment, several keyword patterns from the abstracts (e.g., Pattern 1: web-based learning and biology education) were recruited in well-known databases (e.g., ERIC, EBSCO, Springer Link). Finally, 22 papers were apparent for the current meta-analysis examining the effect of web-based biology learning environment on academic performance. All statistical data from the studies were initially inserted into an Excel sheet and then imported into comprehensive meta-analysis (CMA) statistics software to calculate Hedges' g values. The overall effect-size of web-based biology learning environment pointed to a medium effect. Also, it was found that the educational level and type of experimental design, as moderator variables, did not positively affect the students' academic performance along with web-based biology learning environment. In light of the findings, it can be concluded that web-based biology learning environment is somewhat effective at improving the students' academic performance. The current study recommends that further studies should be undertaken to deepen the implementation processes of the studies with extreme values and explore what makes them unique.

How education level influences internet security knowledge, behaviour, and attitude: a comparison among undergraduates, postgraduates and working graduates.

During the pandemic, the prevailing online learning has brought tremendous benefits to the education field. However, it has also become a target for cybercriminals. Cybersecurity awareness (CSA) or Internet security awareness in the education sector turns out to be critical to mitigating cybersecurity risks. However, previous research indicated that using education level alone to judge CSA level received inconsistent results. This study postulated Social Educational Level (SEL) as a moderator with an extended Knowledge-Attitude-Behaviour model, used students' year level as a proxy for the impact of education level, and used work exposure for the influence of social education level, to compare CSA among undergraduates, postgraduates and working graduates. The participants in the study were divided into six groups, namely year 1 university students, year 2-3university students, final-year students, postgraduate students, young working graduates, and experienced working graduates. The Human Aspects of Information Security Questionnaire was used to conduct a large-scale survey. The multivariate regression model analysis showed significant differences among the knowledge, attitude and behaviour dimensions across groups with different conditions of year-level and work exposure. However, it was found that SEL played a more significant role than an individual's education level. The study suggested that a greater endeavour be committed to educating the public at large together with individuals, institutes, corporate and governments to improve the national CSA level.

Pain and Late-Onset of Hidradenitis Suppurativa Can Have a Negative Influence on Occupational Status and Educational Level. A Cross-Sectional Study.

BACKGROUND AND OBJECTIVES: Hidradenitis suppurativa is a chronic and painful condition with negative impact on daily activity. Little information on the impact of disease-specific factors on educational level and occupational status in hidradenitis suppurativa patients has been reported. We sought to identify how disease-specific factors could influence occupational status and educational level in patients with hidradenitis suppurativa. METHODS: Cross-sectional study of patients with hidradenitis suppurativa seen between September 2017 and September 2018. Disease-specific variables were analyzed to find associations in patients with different educational levels and occupational status. RESULTS: Ninety-eight patients were included. Patients with non-university studies had more frequently≥3 affected areas (22.5% [16/73] vs 4.8% [1/22], p=0.049), a higher number of painful days (8.5 [SD 8.8] vs 4.6 [SD 4.8], p=0.048) and a higher score on the VAS scale (6.7 [SD 2.8] vs 5.0 [3.3], p=0.031). Patients from the inactive group had a significantly increased number of painful days (11.2 [SD 10.4] vs 5.7 [SD 6.2], p=0.004). This group had a greater number of patients with a history of depression (61.3% [19/31] vs 27.4% [17/62], p=0.002) and a higher mean BMI (32.3 [9.1] vs 28.4 [6.4], p=0.016). Late disease onset was significantly associated with being "inactive" (26.7% [8/31] vs 6.5% [4/62], p=0.026). No significant differences between severity scales of hidradenitis suppurativa and educational level or occupational status were found. LIMITATIONS: cross-sectional and single center study. CONCLUSIONS: Pain, ≥3 affected areas, history of depression, higher mean BMI, and late onset of hidradenitis suppurativa, are associated with low education level and inactive occupational status.