Search Results (1,193)

Aims/Background: Polypharmacy, or the concurrent intake of five or more medications, is a significant issue in clinical practice, particularly in multimorbid elderly individuals. Despite its importance for patient safety, medical education often lacks systematic training in recognising and managing polypharmacy within the framework of patient-centred care. We investigated the impact of a structured learning intervention introducing polypharmacy as a chronic condition, assessing whether it enhances medical students’ diagnostic competence, confidence, and interprofessional collaboration. Methods: A prospective cohort study was conducted with 50 final-year medical students who received a three-phase educational intervention. Phase 1 was interactive workshops on the principles of polypharmacy, its dangers, and diagnostic tools. Phase 2 involved simulated patient consultations and medication review exercises with pharmacists. Phase 3 involved reflection through debriefing sessions, reflective diaries, and standardised patient feedback. Student knowledge, confidence, and attitudes towards polypharmacy management were assessed using pre- and post-intervention questionnaires. Quantitative data were analysed through paired t-tests, and qualitative data were analysed thematically from reflective diaries. Results: Students demonstrated considerable improvement after the intervention in identifying symptoms of polypharmacy, suggesting deprescribing strategies, and working in multidisciplinary teams. Confidence in prioritising polypharmacy as a primary diagnostic problem increased from 32% to 86% (p < 0.01), and knowledge of diagnostic tools increased from 3.1 ± 0.6 to 4.7 ± 0.3 (p < 0.01). Standardised patients felt communication and patient-centredness had improved, with satisfaction scores increasing from 3.5 ± 0.8 to 4.8 ± 0.4 (p < 0.01). Reflective diaries indicated a shift towards more holistic thinking regarding medication burden. The small sample size limits the generalisability of the results. Conclusions: Teaching polypharmacy as a chronic condition in medical school enhances diagnostic competence, interprofessional teamwork, and patient safety. Education is a structured way of integrating the management of polypharmacy into routine clinical practice. This model provides valuable insights for designing medical curricula. Future research must assess the impact of such training on patient outcomes and clinical decision-making in the long term. Full article

Background: Vaccine hesitancy (VH) represents a growing concern among healthcare professionals and students, potentially undermining public health efforts. Nursing, pediatric nursing, and midwifery students are future vaccinators and educators, making it essential to understand their attitudes, knowledge, and confidence toward vaccination. This study aims to assess vaccine-related perceptions and behaviors among these student populations in an Italian university. Methods: A cross-sectional survey was conducted between November 2022 and February 2024 at the University of Rome “Tor Vergata”. A structured, anonymous questionnaire, including the Vaccination Attitudes Examination (VAX) scale, vaccine knowledge items, and sources of information, was administered to students in nursing (n = 205), pediatric nursing (n = 46), and midwifery (n = 21). Statistical analyses included descriptive statistics, ANOVA, post hoc tests, and Mann–Whitney U tests. Results: Among the 272 participants, 20.6% reported refusing at least one recommended vaccine, and 18.4% delayed vaccination for non-medical reasons. Vaccine knowledge and confidence increased significantly with academic progression (p < 0.001). Midwifery students showed both the highest concern for long-term vaccine effects and the greatest confidence in vaccine safety. Institutional and scientific sources were the most trusted, though traditional and non-institutional media also influenced perceptions, particularly among midwifery students. Conclusions: Despite high COVID-19 vaccine uptake, VH persists among health professional students. Discipline-specific patterns highlight the need for early, targeted educational strategies to enhance vaccine literacy and reduce hesitancy. Tailored training may empower future professionals to become informed and credible advocates for vaccination. Full article

Introduction: Despite the key role of healthcare workers (HCWs) in tuberculosis (TB) prevention and control, there is a lack of regional data on their knowledge, attitudes, and practices (KAPs) regarding the disease in Atlantic Canada. Objectives: To assess the KAPs of HCWs and identify targets for educational interventions to enhance TB care and control. Methods: A cross-sectional study was conducted among HCWs in Atlantic Canada aged $\ge$19 years from October 2023 to February 2024. Participants were recruited via multiple channels such as social media, collegiate email lists, and snowball sampling. Survey data were collected using an online platform and analyzed using IBM SPSS Statistics v29. KAPs were assessed using Likert-type scales and internal consistency was evaluated using Cronbach’s alpha. Results: A total of 157 HCWs participated in this study (age range: 19 to 69 years); most were women (n = 145, 92%), born in Canada (n = 134, 85.4%), with nearly three-quarters (n = 115, 73.2%) who had never lived outside of Canada. Study participants demonstrated moderately high knowledge (M = 29.32, SD = 3.25) and positive attitudes (M = 3.87, SD = 0.37) towards TB and strong practices (M = 4.24, SD = 0.69) in TB care; however, gaps were identified in HCW abilities to recognize less common TB symptoms (e.g., rash and nausea), as well as inconsistent practices in ventilation and pre-treatment initiation. Internal consistency analysis indicated suboptimal reliability across all three KAP domains, with Cronbach’s alpha values falling below 0.7, thwarting further planned analyses. Conclusions: This study found overall moderate-to-strong TB-related KAPs among HCWs in Atlantic Canada; however, critical gaps in knowledge and practice were noted. This new information can now guide future educational initiatives and targeted training to enhance TB preparedness and ensure equitable care for patients in the region. Full article

Background/Objectives: Medical and nursing students, as future healthcare professionals, influence public trust and vaccine acceptance. Knowledge gaps or misconceptions regarding immunization may undermine their confidence and effectiveness in addressing vaccine hesitancy. This study explores perceptions and attitudes toward childhood vaccination among Bulgarian healthcare students and factors shaping these outcomes. Methods: A cross-sectional survey was conducted in 2024, using an online self-administered questionnaire completed by 374 medical and nursing students. Descriptive statistics were used to analyze vaccine-related responses, comparing attitudes between healthcare programs and education years. Binomial logistic regression was applied to identify predictors of support for mandatory vaccination, first considering demographic and academic variables, and then adding students’ beliefs and common misconceptions. Results: Medical students showed more positive attitudes toward vaccination than nursing students, with 96.8% of medical students versus 89.4% of nursing students believing vaccines are effective (p = 0.005). Students in advanced years demonstrated stronger belief in vaccine effectiveness (p = 0.038). Additionally, misbeliefs about the measles vaccine causing autism decreased significantly, with most students in higher years rejecting this misconception (p = 0.009). Logistic regression revealed that belief in following the vaccine schedule (OR = 22.71; p < 0.001) and confidence in vaccine effectiveness (OR = 10.20; p < 0.001) were the strongest predictors of support for mandatory vaccination, with attitudinal factors explaining over half of the variance. Conclusions: Healthcare students’ attitudes about vaccination influence public health outcomes, as their perspectives reflect experience and beliefs. Targeted vaccine education helps address misconceptions and improve vaccination rates. Full article

Urban areas are at the forefront in addressing global challenges such as climate change and biodiversity loss. Among the key responses are nature-based solutions, which are increasingly being integrated into policy frameworks but which require strong community engagement for their effective implementation. This paper presents the findings of surveys conducted within the Place Lab in Katowice, Poland, an initiative developed as part of an international project and used as a participatory tool for co-creating and implementing green infrastructure. The project applies both place-based and people-centred approaches to support European cities in their transition towards regenerative urbanism. Place Lab activities encourage collaboration between local authorities and residents, enhancing awareness and fostering participation in environmental initiatives. The survey data collected during the project allowed for the evaluation of changes in public attitudes and levels of engagement and for the identification of broader societal phenomena that may influence the implementation of nature-based solutions. The findings revealed, for instance, that more women were interested in supporting the project, that residents tended to be sceptical of governmental actions on climate change, and that views were divided on the trade-off between urban infrastructure such as parking and roads and the presence of green areas. Furthermore, questions of responsibility, awareness, and long-term commitment were frequently raised. Building on the survey results and the existing literature, the study proposes a set of indicators to assess the contribution of citizen participation to the adoption of nature-based solutions. While the effectiveness of nature-based solutions in mitigating climate change impacts can be assessed relatively directly, evaluating civic engagement is more complex. Nevertheless, when conducted transparently and interpreted by experts, indicator-based assessment can offer valuable insights. This study introduces a novel perspective by considering not only drivers of engagement but also the obstacles. The proposed indicators provide a foundation for evaluating community readiness and commitment to nature-based approaches and may be adapted for application in other urban settings and in future research on climate resilience strategies. Full article

Background/objective: Tailoring involves adapting research findings and evidence to suit specific contexts and audiences. This study examines how international stroke guidelines can be tailored to address gait issues after a stroke. Methods: A three-phase consensus method approach was used. A 10-member health experts panel extracted recommendations from three national clinical guidelines in the first phase. In the second phase, 362 physiotherapists completed an online questionnaire to assess the feasibility of adopting the extracted recommendations. In the third phase, a 15-physical therapist consensus workshop was convened to clarify factors that might affect the tailoring process of the extracted recommendations of gait disorder rehabilitation. Results: In phase one, 21 recommendations reached consensus. In the second phase, 362 stroke physiotherapists rated the applicability of these recommendations: 14 rated high, 7 rated low, and none were rejected. The third phase, a nominal group meeting (NGM), explored four themes related to tailoring. The first theme, “organizational factors”, includes elements such as clinical setting, culture, and regulations. The second theme, “individual clinician factors”, assesses aspects like clinical experience, expertise, abilities, knowledge, and attitudes toward tailoring. The third theme, “patient factors”, addresses issues related to multimorbidity, comorbidities, patient engagement, and shared decision-making. The final theme, “other factors”, examines the impact of research design on tailoring. Conclusions: Tailoring international clinical guidelines involves multiple factors. This situation brings home the importance of a systematic strategy for tailoring that incorporates various assessment criteria to enhance the use of clinical evidence. Future research should investigate additional implementation theories to enhance the translation of evidence into practice. Full article

This study aimed to investigate the effects of augmented reality (AR) treadmill walking training on cognitive function, body composition, physiological responses, and acceptance among older adults. Additionally, it analyzed the relationships between body composition, physiological responses, and the acceptance of AR technology. A randomized controlled trial was conducted, recruiting 60 healthy older adults, who were assigned to either the experimental group (AR treadmill walking training) or the control group (traditional treadmill walking training). The assessments included cognitive function evaluation (stride length, walking speed, and balance test), body composition (BMI, skeletal muscle mass, fat mass, and body fat percentage), and physiological responses (heart rate, calorie expenditure, exercise duration, and distance covered). Furthermore, the AR Acceptance Scale was used to assess perceived ease of use, perceived usefulness, attitudes, and behavioral intentions. The results indicated that AR treadmill walking training had significant positive effects on improving cognitive function, optimizing body composition, and enhancing physiological responses among older adults. Compared with the traditional training group, the experimental group demonstrated better performance in stride length, walking speed, and balance tests, with increased skeletal muscle mass and reduced body fat percentage. Additionally, improvements were observed in heart rate regulation, calorie expenditure, exercise duration, and distance covered, reflecting enhanced exercise tolerance. Moreover, older adults exhibited a high level of acceptance toward AR technology, particularly in terms of attitudes and behavioral intentions, as well as perceived usefulness. This study provides empirical support for the application of AR technology in promoting elderly health and suggests that future research should explore personalized adaptation strategies and long-term effects to further expand the potential value of AR technology in elderly exercise. Full article

The transition to a decarbonised energy system in Ireland presents significant socio-technical challenges. This paper, focused on the work of the SMARTLAB project at the Citizen Innovation Lab in Limerick city, investigated the potential of a localised living lab approach to address these challenges. Engaging across 70 buildings and their inhabitants, the project captured the evolution of attitudes and intentions towards the clean energy transition in ways directly relevant to future policy implementation across grid redevelopment, smart service design, and national retrofit. Project methodology was framed by a living lab approach, with wireless energy and indoor environment sensors installed in participant buildings and participant journeys developed by harnessing the Citizen Innovation Lab ecosystem. The results indicate behaviour changes among participants, particularly focusing on indoor environmental conditions. The study concludes that embedded, localised living labs offer a methodological framework which can capture diverse datasets and encompass complex contemporary contexts towards transition goals. Full article

This research addresses two specific knowledge gaps. The first regards the influence of domestic low-carbon technology (LCT) installation approaches and occupier status on user acceptance. The second is to demonstrate the role of machine learning techniques in producing an enhanced model-based understanding of domestic LCT acceptance. Together, these two approaches provide new insights into LCT acceptance through the theory of planned behaviour and demonstrate the value of machine learning for modelling such acceptance. Our aim is therefore to contribute to model-based knowledge about the acceptance of domestic LCTs. Specifically, we contribute new knowledge of the acceptance of LCTs according to the theory of planned behaviour and of the value of machine-learning techniques for modelling this acceptance. Through empirical research using an online quasi-experiment with 3813 English residents, we developed a model of low-carbon technology adoption and evaluated machine learning for model analysis. The design factors were the installation approach and occupier status, with main outcomes including adoption intention, willingness to accept, willingness to pay, attitude, subjective norm, and perceived behavioural control. To examine residents’ technology acceptance, we created two virtual reality models of technology implementation, differing in installation approach. For machine learning analysis, we employed nine techniques for model validation and predictor selection: linear regression, LASSO regression, ridge regression, support vector regression, regression tree (decision tree regression), random forest, XGBoost, k-NN, and neural network. LASSO regression emerged as the best technique in terms of predictor selection, with (near-)optimal model fit (R² and MSE). We found that attitude, subjective norm, and perceived behavioural control significantly predicted the intention to adopt low-carbon technologies. The installation approach influenced willingness to accept, with higher intention for new-build installations than retrofits. Homeownership positively predicted perceived behavioural control, while age negatively predicted several outcomes. This study concludes with implications for policy and future research, a specific emphasis upon contemporary UK policy towards Future Homes Standards, and public information campaigns targeted to specific demographic user groups. This research demonstrates the value of an extended theory of planned behaviour model to study the acceptance of LCTs and the value of machine learning analysis in acceptance modelling. Full article

Background: The migration of healthcare professionals poses a serious threat to health systems worldwide. This study examines attitudes toward brain drain and the factors influencing migration tendencies among medical and nursing students in Albania, with particular attention to nursing workforce implications. Methods: A cross-sectional study was conducted with 610 students in the 2024–2025 academic year using the 16-item Brain Drain Attitude Scale (BDAS). Socio-demographic and academic data were also collected. Results: The mean BDAS score was 53.43 ± 16.88. Pull factors (mean: 40.25 ± 12.76) were stronger motivators than push factors (mean: 13.19 ± 4.13). A total of 487 nursing, 73 midwifery-nursing, and 50 medical students participated (95% response rate). Nearly 40% expressed a desire to work abroad, citing financial prospects (48.2%), better living standards (46%), and personal freedom (42.1%) as reasons. Higher migration tendencies were seen in females (β = 0.50, p = 0.049), medical students (β = 1.01, p = 0.001), and third-year students (β = 0.46, p = 0.011). Conclusions: Migration tendencies are high among future Albanian healthcare professionals, with significant implications for the nursing workforce. Targeted policies are urgently needed to address brain drain through workforce investment and retention strategies. Full article

This research is focused on exploring the importance of STEM (Science, Technology, Engineering, and Mathematics) education in the development of critical competencies among secondary school students in the 21st century. This was aimed to assess the impact of STEM-based activities on students’ creative and computational thinking skills. A quasi-experimental design that included 77 secondary school students from public and private schools in Bandar Lampung, Indonesia, who participated in STEM interventions for over 5 weeks, was adopted. Data were collected through creative thinking tests and questionnaires on CT and STEM attitudes. The results showed that students who participated in STEM activities exhibited significantly higher creative thinking scores compared to peers taught with the traditional curriculum. Specifically, the experimental group showed a progressive increase in weekly test scores, suggesting that STEM methods improved students’ performance over time. Structural equation modeling (SEM) disclosed strong positive associations between attitudes towards STEM, CT, and creativity. The implications of these results outlined the need to integrate STEM education into curricula to foster essential skills for future challenges. This research contributes to the understanding of effective educational strategies and also advocates for a shift towards more interactive and integrative methods in secondary education to meet the demands of the contemporary workforce. Full article

Antibiotic resistance presents a global threat, making the swift development of alternative treatments essential. Phage therapy, which employs bacterial viruses that specifically target bacteria, shows promise. Although this method has been utilized for over a century, primarily in Eastern Europe, its use in the US remains limited. This study aimed to assess the awareness and willingness of US healthcare providers to adopt phage therapy in response to the growing issue of antibiotic resistance. A survey of 196 healthcare providers, primarily MDs and DOs, found that while 99% were aware of antimicrobial resistance, only 49% were knowledgeable about phage therapy as a treatment for resistant bacterial infections. Nonetheless, 56% were open to considering phage therapy, and this willingness was associated with prior knowledge, concerns about antibiotic resistance, previous training, and confidence in recommending it (p < 0.05). Our study of U.S. healthcare providers revealed key findings about their views on phage therapy as a potential alternative for treating bacterial infections. Credible information is essential to promoting phage therapy use among U.S. providers via educational initiatives, clinical guidance, and research dissemination to promote phage therapy use among U.S. providers. Evidence-based education and clinical guidance help providers make sound decisions on the appropriate and safe use of phage therapy. Full article

In the era of homogenized competition, brand knowledge has become a critical factor that influences consumer purchasing decisions. However, traditional single-layer network models fail to capture the multi-dimensional semantic relationships embedded in brand-related textual data. To address this gap, this study proposes a BKMN framework integrating TF-IDF and TextRank algorithms for comprehensive brand knowledge discovery. By analyzing 19,875 consumer reviews of a mobile phone brand from JD website, we constructed a tri-layer network comprising TF-IDF-derived keywords, TextRank-derived keywords, and their overlapping nodes. The model incorporates co-occurrence matrices and centrality metrics (degree, closeness, betweenness, eigenvector) to identify semantic hubs and interlayer associations. The results reveal that consumers prioritize attributes such as “camera performance”, “operational speed”, “screen quality”, and “battery life”. Notably, the overlap layer exhibits the highest node centrality, indicating convergent consumer focus across algorithms. The network demonstrates small-world characteristics (average path length = 1.627) with strong clustering (average clustering coefficient = 0.848), reflecting cohesive consumer discourse around key features. Meanwhile, this study proposes the Mul-LSTM model for sentiment analysis of reviews, achieving a 93% sentiment classification accuracy, revealing that consumers have a higher proportion of positive attitudes towards the brand’s cell phones, which provides a quantitative basis for enterprises to understand users’ emotional tendencies and optimize brand word-of-mouth management. This research advances brand knowledge modeling by synergizing heterogeneous algorithms and multilayer network analysis. Its practical implications include enabling enterprises to pinpoint competitive differentiators and optimize marketing strategies. Future work could extend the framework to incorporate sentiment dynamics and cross-domain applications in smart home or cosmetic industries. Full article

The growing urgency of the climate crisis has heightened the importance of integrating sustainability into health education. Allied health professionals are well positioned to lead sustainable healthcare efforts, yet evidence suggests a persistent gap between student awareness and formal training. This study explored the perspectives, knowledge, and attitudes of Portuguese allied health students regarding sustainability. An online and anonymous cross-sectional survey was conducted among undergraduate and graduate students across multiple allied health disciplines. The questionnaire assessed general knowledge, perceptions of curricular integration, and attitudes toward sustainable clinical practice. A total of 247 (response rate of 8.23%) students participated, with the majority expressing high concern about climate change and strong support for environmentally responsible healthcare. However, the results revealed inconsistent awareness of healthcare’s environmental footprint and a limited exposure to structured sustainability education. Friedman tests indicated significant variability in students’ knowledge, perceived responsibility, and curricular experiences. Students identified priority themes for curricular inclusion—such as the environmental impact of the health system—and recognized their alignment with the UN Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health) and SDG 13 (Climate Action). The findings highlight the need for the systematic, competency-based integration of sustainability into allied health curricula to support a climate-resilient and ecologically responsible future healthcare workforce. Full article

Background: This article introduces the development and application of a life review program designed to support the psychological well-being of middle-aged and older adults living with HIV. Grounded in Swanson’s Theory of Caring, the program emphasizes culturally sensitive, narrative-based reflection and group sharing. Methods: This study employed a qualitative exploratory design, implementing an eight-week life review program based on Swanson’s Theory of Caring. Data were collected through in-depth interviews and participant observations and then analyzed using qualitative content analysis. Results: Thematic analysis revealed that participants experienced emotional engagement, renewed self-understanding, and a sense of connection fostered by the caring-based narrative process. Participants also expressed positive attitudes toward reinterpreting their past and envisioning the future. Conclusions: Rather than evaluating intervention outcomes, this study focuses on the development and implementation of a caring-based life review tool. Findings illustrate its feasibility and cultural acceptability, offering a foundation for future adaptation across diverse supportive care settings. This culturally sensitive intervention represents one of the first applications of a caring-based life review program tailored to aging PLWHIV in Taiwan. Full article