Search Results (2,949)

Background: Ethical decision-making in medical care increasingly requires balancing clinical values, professional duties, and organizational reasoning. Understanding how healthcare professionals navigate moral dilemmas necessitates examining the philosophical orientations that shape their ethical judgments. Alongside traditional medical ethics, a business ethics perspective highlights organizational and managerial dimensions of healthcare, offering a more comprehensive understanding of ethical decision-making in modern clinical contexts. Aim: This study aims to examine how healthcare professionals reason about ethical dilemmas by mapping their moral orientations and decision-making patterns across five ethical frameworks-idealism, relativism, objectivism, legalism, and Machiavellianism-integrating both medical and business ethics perspectives. Methods: A cross-sectional study was conducted with 277 participants (medical doctors and students). Two validated instruments were used: the Attitudes Toward Business Ethics Questionnaire (ATBEQ) to assess moral orientations and the Clinical Ethical Dilemmas Questionnaire (Richeux & Duquéroy) to evaluate ethical decision patterns. Data were analyzed using correlation, multiple regression, and k-means cluster analyses. Results: Among the five orientations, Legalism negatively predicted “It depends” responses (i.e., higher Legalism scores were associated with fewer indecisive responses), indicating greater decisiveness in ethically ambiguous situations. Unexpected positive correlations were also found between traditionally opposing constructs-such as Ethical Relativism and Moral Objectivism-suggesting moral pluralism. The overall regression model was not statistically significant (R² = 0.04, p = 0.08). Cluster analysis identified four distinct ethical reasoning profiles: High Machiavellian Idealists, Pragmatic Relativists, Context-Sensitive Objectivists, and Ethical Purists. Conclusions: Abstract philosophical orientations showed limited predictive power for contextual ethical decision-making, highlighting the complex and multidimensional nature of moral reasoning in healthcare. Findings inform the design of context-sensitive ethics education programs that integrate philosophical reflection with case-based learning to strengthen ethical competence among medical professionals. Full article

Background/Objectives: Strengthening management competencies are essential to ensure effective and equitable Primary Health Care (PHC) systems. Emerging perspectives suggest that effective leadership in PHC could benefit from integrating cognitive, emotional, and social competencies. Although there is existing evidence on the required competencies worldwide and the characterization of PHC managers in Chile, no study has yet developed or validated a specific competency profile for these positions. This study developed and validated a competency profile for PHC managers to provide an evidence-based and context-specific tool for leadership, training, and evaluation. Methods: A mixed-method observational study based on expert judgment was conducted across three Chilean macrozones (northern, central, and southern), involving 36 professionals with recognized experience in PHC management identified through direct contact and snowball sampling. Quantitative validation through the Content Validity Index (CVI) confirmed high expert agreement (CVI ≥ 0.90), while thematic analysis of qualitative responses led to the inclusion of new areas. Results: The final profile comprises 47 competencies organized into knowledge, skills, and attitudes, emphasizing executive functions and social cognition and incorporating emerging domains such as emotional intelligence and institutional support. Beyond managerial relevance, the profile offers a structured framework for designing, implementing, and evaluating competency-based education and training in health sciences. Conclusions: These results also support leadership development and performance assessment, providing an evidence-based reference for professional training initiatives in PHC. This profile emphasizes that leadership development should not be limited to technical competencies, but also encompasses emotional, cognitive, and social dimensions essential for effective performance. Full article

Endometriosis is a common gynecological pathology, with an incidence of nearly 10% in patients of reproductive age, and is still underdiagnosed. A thorough and well-spread diagnostic study of endometriosis based on epigenetic factor dysregulation can highlight potential areas for improvement. To quantify the potential and utility of non-invasive tools in the early diagnosis of endometriosis, an overview of current knowledge on epigenetic factors, based on DNA and RNA, is presented. Among these tools, it is important to highlight the role of miRNAs (microRNAs), cfDNA (cell-free DNA), and rRNAs (ribosomal RNAs), which are small molecules involved in endometriosis and numerous other pathologies. To evaluate their potential and utility in endometriosis, a salivary miRNA diagnostic test was conducted, the cfDNA methylation patterns of fragmented DNA circulating in bodily fluids (e.g., plasma) were analyzed, and cervical and uterine microbiomes were profiled for bacterial rRNA in patients with clinical suspicion of incipient endometriosis. Specific molecular profiles associated with endometriosis were analyzed. The first profile, a 109-miRNA saliva signature, was validated as a product of miRNA biomarkers and artificial intelligence modeling. In addition, peripheral blood cfDNA methylation biomarkers were identified by investigating nine genes in a molecular signature that requires validation. A profile was also obtained from cervical swabs and uterine washes, including molecular analysis of 16S rRNA amplicon sequencing to evaluate alterations in the cervical bacterial community. This review aims to optimize the integration of a non-invasive diagnostic tool for early endometriosis diagnosis. Genetic biomarkers can be correlated with clinical factors to improve diagnostic accuracy. Of the assessed diagnostic tools, salivary miRNA tests, a peripheral blood cfDNA methylation biomarker, and a microbiome rRNA signature may be useful for early diagnosis of endometriosis, as well as, implicitly, therapeutic attitude and follow-up. Full article

Research in “cybertherapy” has explored innovative ways to integrate new technologies as innovative tools in psychological treatment, such as virtual reality. Avatars, as digital representations of users within virtual environments, represent an interesting tool for psychotherapists: they could be used to assess aspects of patients’ self-representations (assessment), to promote behavioral change based on an alternative self-image (treatment), or to exercise therapists’ skills in diagnosis and assessment (formation). Yet, the use of avatars in psychotherapy is still not widespread. In the present study, 77 certified psychotherapists evaluated the three possible uses of avatars described above in terms of technology acceptance model (TAM) factors: perceived usefulness, perceived ease of use and intention-to-use. Partially confirming the TAM, the results show that perceived usefulness in particular is an effective predictor of intention to use avatars in psychotherapy for all three possible uses. Attitudes towards avatars as a psychotherapeutic tool were slightly influenced by mental health professionals’ methodological approach, with cognitive-behavioral psychotherapists showing more positive attitudes towards avatars as a training tool. On the other hand, previous experiences with other technologies (e.g., conducting therapy online or not) affected the perception of avatars’ ease of use as a treatment tool. The present study contributes to identifying factors that influence mental health professionals’ attitudes towards technological innovations in the psychotherapy profession, giving directions for future research in cybertherapy adoption. Full article

Climate change poses a major global health threat, with healthcare systems contributing substantially to global greenhouse gas emissions. Health professionals and students play an essential role in advancing sustainable practice, yet many lack the knowledge, skills, and confidence needed to address the environmental impacts of healthcare. This study aims to co-design and evaluate a gamified e-resource that enhances pre-registration health profession students’ knowledge, self-efficacy, and attitudes towards healthcare decarbonisation, while encouraging sustainable behaviour change. A sequential explanatory design will be employed in three phases: (1) a scoping review of the literature; (2) four co-design workshops with students (n = 20) followed by post-workshop focus groups using focused ethnography to explore co-design experiences; and (3) pre- and post-test questionnaires (n = 200) assessing knowledge, attitudes, self-efficacy, behaviours, willingness to act, and usability, followed by focus groups (n = 30) exploring behavioural changes after using the e-resource. The study will generate evidence on how a co-designed, gamified e-resources influence student learning and engagement with healthcare decarbonisation. Findings will inform the integration of sustainability and decarbonisation principles within education and support efforts to equip future health professionals with the competencies required for a low-carbon healthcare system. Full article

Objective: Body awareness is the conscious, subjective multimodal integration of body-related sensitivity from bodily signals—detecting states and subtle reactions to internal and environmental conditions—modifiable by attention, interpretation, appraisal, beliefs, memories, conditioning, attitudes, and affect. The aim of our study is to identify patient-reported outcome measures (PROMs) of BA and evaluate their psychometric properties and cross-cultural adaptation processes. Literature Survey: We searched PubMed, Scopus, and PsycINFO; the last search was conducted on 1 July 2025. Methodology: We included studies that psychometrically evaluated PROMs regarding BA in the general adult population and their translations into other languages, with no time-range restrictions. Study selection was performed independently by two reviewers in a blind manner. Evaluation followed COSMIN guidance for systematic reviews of PROMs: (1) risk of bias assessment, (2) application of quality criteria for measurement properties, and (3) GRADE rating of the certainty of evidence. Synthesis: We identified 12 BA questionnaires and more than 30 cross-cultural adaptations, from a total of 50 studies. In summary, the Revised Body Awareness Rating Questionnaire and the Multidimensional Assessment of Interoceptive Awareness (MAIA 1 and 2) showed good results for structural validity and internal consistency, which were the most frequently assessed psychometric properties. In contrast, construct validity was highly variable, and the findings on reliability were far from optimal. MAIA-2 was one of the most studied and showed stronger evidence and better pooled results (4 out of 5 properties) than other instruments. Conclusions: The psychometric quality of BA PROMs varies widely, reflecting challenges in operationalizing the construct of body awareness and related domains. While MAIA-2 currently presents the most acceptable—though still imperfect—evidence, further high-quality studies are needed to strengthen their measurement properties and clarify construct coverage. Full article

Background/Objectives: Artificial intelligence (AI)-based chatbots present a viable approach to overcoming several challenges associated with conventional psychotherapy, such as high financial costs, limited access to mental health professionals, and geographical or logistical barriers. Thus, these chatbots are increasingly employed as complementary tools to traditional therapeutic practices in mental health care. Our aim was to develop and validate a scale to measure attitudes toward the use of AI-based chatbots for mental health support, i.e., the Artificial Intelligence in Mental Health Scale (AIMHS). Methods: A multidisciplinary panel of experts assessed the content validity. To confirm face validity, we carried out cognitive interviews and calculated the item-level face validity index. We applied factor analysis to verify the construct structure. We assessed measurement invariance across demographic subgroups. Concurrent validity was evaluated using three valid instruments. Reliability was tested through Cronbach’s alpha, Cohen’s kappa, and the intraclass correlation coefficient. Results: Factor analysis supported a two-factor five-item model. The two factors were technical and personal advantages, and explained 81.28% of the variance. The AIMHS demonstrated adequate concurrent validity, evidenced by statistically significant correlations with Artificial Intelligence Attitude Scale (r = 0.405, p-value < 0.001), Attitudes Towards Artificial Intelligence Scale (acceptance subscale; r = 0.401, p-value < 0.001, fear subscale; r = −0.151, p-value = 0.002), and Short Trust in Automation Scale (r = 0.450, p-value < 0.001). Configural, metric and scalar invariance were supported by our findings. Cronbach’s alpha was 0.798, and intraclass correlation coefficient was 0.938. Cohen’s kappa for the five items ranged from 0.760 to 0.848. Conclusions: The AIMHS is a five-item psychometrically sound and user-friendly instrument capturing two dimensions; technical and personal advantages. Future research should be undertaken to further evaluate the psychometric properties of the AIMHS across diverse populations and contexts. Full article

The stability of unmanned aerial vehicles (UAVs) during propulsion failure remains a critical safety challenge. This study presents a center-of-mass (CoM) correction device, a compact, under-slung, and dual-axis prismatic stage, which can reposition a dedicated shifting mass within the UAV frame to generate stabilizing gravitational torques by the closed-loop feedback from the inertial measurement unit (IMU). Two major experiments were conducted to evaluate the feasibility of the system. In a controlled roll test with varying payloads, the device produced a corrective torque up to 1.2375 N·m, reducing maximum roll deviations from nearly 90° without the device to less than 5° with it. In a dynamic free-fall simulation, the baseline UAV exhibited rapid tumbling and inverted impacts, whereas with the CoM system activated, the UAV maintained a near-level attitude to achieve the upright recovery and greatly reduced structural stress prior to ground contact. The CoM device, as a fail-safe stabilizer, can also enhance maneuverability by increasing control authority, enable a faster speed response and more efficient in-air braking without reliance on the rotor thrust, and achieve comprehensive energy saving, at about 7% of the total power budget. In summary, the roll stabilization and free-fall results show that the CoM device can work as a practical pathway toward the safer, more agile, and energy-efficient UAV platforms for civil, industrial, and defense applications. Full article

This study presents the design and implementation of a real-time flight-path tracking control system for a quadrotor unmanned aerial vehicle (UAV) capable of accurately following a mobile ground target under dynamic and uncertain environmental conditions. The proposed framework integrates classical fixed-gain PID regulation executed on Pixhawk with its built-in adaptive mechanisms, namely autotuning, hover-throttle learning, and dynamic harmonic notch filtering, to enhance robustness under communication latency and disturbances. No machine learning PID tuning is used on Pixhawk; adaptive features are estimator based rather than ML based. The proposed system addresses critical challenges in trajectory tracking, including real-time delay compensation between the UAV and rover, external perturbations, and the requirement to maintain stable six-degree-of-freedom (DOF) control of altitude, yaw, pitch, and roll. A dynamic mathematical model, formulated using ordinary differential equations with embedded delay elements, is developed to emulate real-world flight behavior and validate control performance. Experimental evaluation demonstrates robust path-tracking accuracy, attitude stability, and responsiveness across diverse terrains and weather conditions, achieving a mean positional error below one meter and effective resilience against an 8.2 ms communication delay. Overall, this work establishes a scalable, computationally efficient, and high-precision control framework for UAV guidance and cooperative ground-target tracking, with potential applications in autonomous navigation, search-and-rescue operations, infrastructure inspection, and intelligent surveillance. The term “delay-aware” in this work refers to the explicit modeling of the measured 8.2 ms end-to-end delay and the use of Pixhawk’s estimator-based adaptive mechanisms, without any machine learning-based PID tuning. Full article

Individual behaviors play a crucial role in generating and mitigating plastic pollution. Understanding citizen knowledge and perceptions is therefore critical to inform effective public interventions. Surveys can provide this information, but they must use well-designed and culturally adapted tools to be reliable. We present the Italian cross-cultural adaptation of an Australian questionnaire identified via systematic review as meeting high-quality standards. The tool included 21 items (Likert-scale, multiple-choice, and open-ended). In accordance with literature indications, we performed forward and back translation and subsequent review by an Expert Committee, producing a pre-final version. A stratified sample of 43 citizens assessed clarity of each item and provided feedback, which guided further Expert Committee revision. Ten items showed comprehension problems, and seven of them were rephrased because they were confusing or redundant. Items with technical terms such as “bioplastics” and “biodegradable” proved challenging, leading to the addition of brief explanations in the introduction to the questionnaire. This process produced a rigorously developed, culturally appropriate instrument for assessing public understanding of plastic pollution in Italy. This standardized tool, if adapted in multiple languages, will enable international surveys and meta-analyses to guide global strategies. Psychometric validation is recommended before large-scale deployment of the tool. Full article

Background: To evaluate women’s satisfaction with gynecological services at a public referral facility, recognizing the importance of patient satisfaction in assessing healthcare quality. Methods: Patient satisfaction was assessed with a 52-item questionnaire, targeting women undergoing laparoscopy/laparotomy, operative and office hysteroscopy, hormonal diagnostics, and others. The impact of patient-specific and hospitalization-related variables on satisfaction indicators and the relationships between provider-specific factors, expectation fulfillment, and readmission willingness were analyzed. Additionally, the institution’s organizational culture was evaluated. Results: Analysis of 790 questionnaires revealed a median satisfaction score of 88.48% and scores of 92.31%, 89.42%, 88.18%, 88.33%, and 85% across groups, with the highest satisfaction for laparoscopy/laparotomy (p = 0.003). Expectation fulfillment and total satisfaction relied on devoted time and alternatives discussion (both p = 0.001 and <0.001, respectively), positively correlating with comprehension, sense of security, and information quality (all p < 0.001). Readmission willingness was affected by devoted time (p = 0.016) and alternatives discussion (p = 0.028), and positively correlated with sense of security (p = 0.01). Expectation fulfillment and total satisfaction for office hysteroscopy depended on ongoing information (both p < 0.001) and pain aspects, positively correlating with comprehension, communication, and security, but negatively with pain (all p < 0.001), without affecting readmission willingness. Significant correlations existed between patient-specific and hospitalization-related variables and satisfaction, expectation fulfillment, and readmission willingness. A hierarchical culture with clan orientation was identified. Conclusions: Women’s high satisfaction was primarily linked to information quality. Readmission willingness correlated with a sense of security. Communication was crucial during office hysteroscopy. Public healthcare setting did not affect staff attitudes. Clan-oriented hierarchical culture favored a sense of security. Full article

Background/Objectives: Musculoskeletal disorders (MSDs) contribute to work disability arising from personal and work-related physical, organizational and psychosocial factors that often differentially affect men and women. We aimed to identify determinants of the sex/gender difference in duration of MSD work absence through a mixed-studies systematic review. Methods: We synthesized evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach adapted to prognostic studies and meta-ethnography for qualitative studies, followed by a mixed synthesis. Results: Twenty-six quantitative and four qualitative studies contributed to the evidence synthesis. Only two of the twenty-six quantitative studies addressed the sex/gender gap directly, compared to three of the four qualitative studies. Most other quantitative studies provided evidence from sex/gender-stratified analyses of determinants of MSD disability. The synthesis of qualitative studies suggested that domestic strain, less access to modified work/retraining, and gender-biased attitudes of health and insurance system gatekeepers hindered women’s return to work. Prognostic factors in women supporting this conclusion from quantitative studies included the combination “working ≥ 40 h/week and having dependents” and low supervisor support. The mixed synthesis yielded a conceptual model of hypothesized determinants of the sex/gender difference in MSD work disability that integrates factors from personal, workplace, healthcare and insurance–disability management spheres, influenced by the larger sociopolitical, cultural and macroeconomic context. Conclusions: Studies directly addressing the sex/gender gap in MSD disability are needed. These can be informed by the proposed model. Practitioners and policymakers can build upon the model to develop and implement MSD prevention and rehabilitation interventions tailored to the needs of men and women to reduce sex/gender disparities. Full article

Unmanned Aerial Vehicles (UAVs) are integral components of future 6G networks, offering rapid deployment, enhanced line-of-sight communication, and flexible coverage extension. However, UAV communications in low-altitude environments face significant challenges, including rapid link variations due to attitude instability, severe signal blockage by urban obstacles, and critical sensitivity to transmitter–receiver alignment. While traditional planar reconfigurable intelligent surfaces (RIS) show promise for mitigating these issues, they exhibit inherent limitations such as angular sensitivity and beam squint in wideband scenarios, compromising reliability in dynamic UAV scenarios. To address these shortcomings, this paper proposes and evaluates a spherical-cap reflective intelligent surface (ScRIS) specifically designed for dynamic low-altitude communications. The intrinsic curvature of the ScRIS enables omnidirectional reflection capabilities, significantly reducing sensitivity to UAV attitude variations. A rigorous analytical model founded on Generalized Sheet Transition Conditions (GSTCs) is developed to characterize the electromagnetic scattering of the curved metasurface. Three distinct 1-bit RIS unit cell coding arrangements, namely alternate, chessboard, and random, are investigated via numerical simulations utilizing CST Microwave Studio and experimental validation within a mechanically stirred reverberation chamber. Our results demonstrate that all tested ScRIS coding patterns markedly enhance electromagnetic field uniformity within the chamber and reduce the lowest usable frequency (LUF) by approximately 20% compared to a conventional metallic spherical reflector. Notably, the random coding pattern maximizes phase entropy, achieves the most uniform scattering characteristics and substantially reduces spatial field autocorrelation. Furthermore, the combined curvature and coding functionality of the ScRIS facilitates simultaneous directional focusing and diffuse scattering, thereby improving multipath diversity and spatial coverage uniformity. This effectively mitigates communication blind spots commonly encountered in UAV applications, providing a resilient link environment despite UAV orientation changes. To validate these findings in a practical context, we conduct link-level simulations based on a reproducible system model at 3.5 GHz, utilizing electromagnetic scale invariance to bridge the fundamental scattering properties observed in the RC to the application band. The results confirm that the ScRIS architecture can enhance link throughput by nearly five-fold at a 10 km range compared to a baseline scenario without RIS. We also propose a practical deployment strategy for urban blind-spot compensation, discuss hybrid planar-curved architectures, and conduct an in-depth analysis of a DRL-based adaptive control framework with explicit convergence and complexity analysis. Our findings validate the significant potential of ScRIS as a passive, energy-efficient solution for enhancing communication stability and coverage in multi-band 6G networks. Full article

Foodborne diseases remain a persistent public health problem. Most foodborne outbreaks in Europe occur in consumers’ homes, highlighting that improvements in consumer food safety are needed and that consumers have an important role in maintaining food safety. A better understanding of consumer food safety knowledge, attitudes, and food handling practices is required to prepare effective interventions. The aim of this study was to evaluate consumer food safety knowledge, attitudes, and food handling practices in Slovenia as well as the interrelationships between knowledge, attitudes, and practices. Adult consumers in Slovenia (n = 1621) participated in a validated online questionnaire. The questionnaire included demographic characteristics and explored the aspects of knowledge, attitudes, and practices on the following topics: food related habits, food shopping and transportation, food refrigeration, food labeling, and food preparation. Data were analyzed using descriptive statistics and structural equation modeling (SEM). Overall, participants demonstrated good levels of knowledge, attitudes, and practice. However, some of the areas that require improvement include use of cooling bags, measuring and knowing the correct refrigerator temperature and not washing raw meat and poultry. SEM analysis revealed that knowledge affects attitudes and, in most cases, both knowledge and attitudes affect practices. Enhanced communication strategies targeting consumers are needed to reduce the risk of foodborne illnesses. Educational campaigns need to focus on all three aspects: knowledge, attitudes, and practices. Building a culture of consumer food safety is essential because consumer food safety truly is everyone’s business. Full article

Background/Objectives: Eating behavior disorders (EBDs) are a public health concern among undergraduate students. Evidence suggests that certain health-related academic environments may be associated with heightened psychological vulnerability. Hence, we aimed to evaluate the association between nursing education and the risk of EBDs and to assess whether self-esteem and anxiety mediate this relationship. Methods: A cross-sectional analytical study was conducted between July and August 2023 among 433 undergraduate students from two public universities in Hidalgo, Mexico. The sample included 209 nursing students and 224 peers from non-health-related programs. Self-esteem, anxiety, and EBD risk were assessed using the Rosenberg Self-Esteem Scale, Hamilton Anxiety Rating Scale, and Eating Attitudes Test-26, respectively. Logistic regression and counterfactual mediation analyses were performed, adjusting for age, sex, family income, and year of study. Results: Nursing students showed higher odds of low self-esteem (aOR = 1.64; 95% CI: 1.06–2.53), anxiety (aOR = 2.06; 95% CI: 1.25–3.37), and EBDs risk (aOR = 2.37; 95% CI: 1.37–4.09) compared with non-health peers. Mediation analyses revealed significant indirect effects through self-esteem (aOR = 1.20; 95% CI: 1.03–1.38) and anxiety (aOR = 1.14; 95% CI: 1.01–1.29). Conclusions: Nursing education was independently associated with a higher risk of EBDs, with statistical mediation analyses indicating that differences in self-esteem and anxiety may help characterize this association. Self-esteem exerted a slightly stronger indirect effect, suggesting that negative self-evaluation may represent a more proximal psychological process rather than a causal determinant. Full article