Search Results (4,058)

(1) Background: Working from home is becoming increasingly common and has many advantages, but also negative consequences such as reduced physical activity, poor ergonomics and stress. Many people find it difficult to attend in-person rehabilitation sessions due to transportation barriers and limited access to rehabilitation facilities. Therefore, the aim of our study was to investigate whether our online preventive exercise programme effectively improves the musculoskeletal and mental health of sedentary workers. (2) Methods: The study participants worked from home on a long-term basis. Our research group consisted of 30 people, 16 in the intervention group and 14 in the control group. The intervention group members participated in a complex preventive exercise programme three times a week for 10 weeks. The training took place online. Before and after the exercise programme, various tests were used to assess the functional status of the participants’ spine, the strength and flexibility of their core muscles (Core, Kempf and Kraus–Weber tests) and their mental state (Beck Depression Inventory). (3) Results: Significant improvement was observed in the intervention group in the Core, Kempf, Kraus–Weber and Beck tests. (4) Conclusions: Our online complex training programme proved to be effective during the evaluation. It is crucial to tailor remote rehabilitation services to the individual needs and preferences of patients and healthcare professionals. Full article

The unimolecular alkene elimination reaction class of fatty acid alkyl esters (FAAEs) is a crucial component in the low-temperature combustion mechanism for biodiesel fuels. However, thermo-kinetic parameters for this reaction class are scarce, particularly for the large-size molecules over four carbon atoms and intricate branched-chain configurations. Thermo-kinetic parameters are essential for constructing a reaction mechanism, which can be used to clarify the chemical nature of combustion for biodiesel fuels. In this paper, the B3LYP method, in conjunction with the 6-311G(d,p) basis set, is used to carry out geometry optimization of the species participating in the reactions. Frequency calculations are further executed at the same level of theory. Additionally, coupled with the 6-311G(d,p) basis set, the B3LYP method acts as the low-level ab initio approach, while the Gaussian-4 (G4) composite method serves as the high-level ab initio approach within the isodesmic reaction correction scheme. The CCSD(T) approach is employed to verify the consistency of the electronic energy ascertained through the G4 method. The isodesmic reaction method (IRM) is used to obtain the energy barriers and reaction enthalpies for unimolecular alkene elimination reaction class of FAAEs. Based on the reaction class transition state theory (RC-TST), high-pressure-limit rate coefficients were computed, with asymmetric Eckart tunneling corrections applied across 500~2000 K temperature range. Rate rules at the high-pressure-limit are obtained through the averaging of rate coefficients from a representative collection of reactions, which incorporate substituent groups and carbon chains with different sizes and lengths. Ultimately, the energy barriers, reaction enthalpies, and rate rules at the high-pressure-limit and kinetic parameters expressed as (A, n, E) are supplied for developing the low-temperature combustion mechanism of biodiesel fuels. Full article

Electoral abstention is a growing phenomenon in contemporary democracies, raising concerns about the representativeness and legitimacy of elected governments, particularly in Portugal where youth participation remains low. This study explores the heterogeneity of non-voting behavior by comparing insights from voters and non-voters through online focus groups. Employing content analysis on qualitative data from 42 participants, the research identifies distinct non-voter profiles, systemic barriers, and potential pathways to increased participation. Key findings reveal heterogeneous abstainer types—including disbelieving citizens, disinterested youth, pragmatic non-voters, and protest non-voters—driven by distrust, practical obstacles, and insufficient political literacy. Despite non-voting, many express conditional willingness to participate in high-stakes scenarios or following reforms. The study concludes that addressing these barriers requires holistic measures, such as enhanced civic education, technological voting modernization, and improved political representation, to foster trust and democratic engagement. These insights offer actionable recommendations for policymakers to enhance voter turnout and strengthen democratic legitimacy. Full article

Collaborative Online International Learning (COIL) has become an innovative pedagogical strategy that promotes the internationalization of curricula and the development of transversal competencies. In architecture, its implementation is particularly relevant because there is a growing need to train professionals capable of leading and collaborating in global and interdisciplinary contexts. However, evidence of COIL’s impact during the early stages of higher education in Latin America remains limited. This study analyzed the experience of 39 architecture students from the Universidad Nacional de San Agustín de Arequipa (Peru), who collaborated with peers from Mexico in a five-week COIL project focused on design methodologies for vulnerable populations. Using a mixed-methods approach, the study assessed students’ competencies in leadership, self-regulation in virtual learning, and emotional intelligence and teamwork through pre- and post-experience questionnaires complemented with open-ended questions. Findings indicate that although students’ self-perceptions of their competencies remained at medium-to-high levels overall, changes occurred differently among groups: students with initially low self-assessment scores showed improvements, whereas those with initially high scores tended to moderate their self-assessment. Qualitative analysis highlighted barriers such as limited communication, time zone differences, and unequal participation. Overall, the results suggest that the COIL experience not only supported the development of competencies but also fostered critical reflection and a more realistic self-assessment of students’ competencies in virtual and intercultural contexts. Full article

Introduction: Health literacy (HL) is a key determinant of health outcomes, particularly among vulnerable populations such as low-income older adults. Limited HL is associated with poor understanding of medication instructions and lower medication adherence, which can compromise therapeutic success. This study aims to assess the levels of HL and medication adherence among low-income older adults and to analyse the relationship between HL, medication adherence, and other determinants. Methods: A cross-sectional study was conducted among low-income older adults in Portugal’s Beira and Serra Estrela Region. HL was assessed using the European Health Literacy Survey Questionnaire (HLS-EU-PT), and medication adherence was measured with the Adherence to Treatment Measure (MAT) scale. Descriptive statistics, Spearman correlations, ordinal logistic regression, and linear regression were used to analyse associations between HL, adherence, and sociodemographic and health factors. Results: Of 196 participants, most had problematic or inadequate HL (87.8%). Medication adherence was relatively high (mean = 5.37, SD = 0.54). HL was positively associated with medication adherence (R = 0.260, p < 0.001), education (R = 0.277, p < 0.001), and ability to pay expenses (R = 0.235, p = 0.002) and negatively with age (R = −0.179, p = 0.019), poor health status (R = −0.237, p = 0.002), and difficulty affording medication (R = −0.389, p < 0.001). Completion of the third cycle of primary education predicted higher HL (OR = 1.939, 95% CI: 0.088–3.790, p = 0.040); the ability to pay expenses predicted better adherence (B = 0.101, 95% CI: 0.014–0.187, p = 0.022). Conclusions: Low HL remains a significant barrier among low-income older adults in Portugal, despite generally high medication adherence. Education and financial stability are key determinants to HL and adherence. Interventions should integrate HL promotion with efforts to reduce socioeconomic barriers and support medication management in the vulnerable populations. Full article

Background/Objectives: Adults with type 1 diabetes (T1D) experience disproportionately high rates of depression, anxiety, and psychological distress, yet integration of behavioral health into diabetes care remains limited. The objective of this study was to identify barriers and facilitators to mental health treatment among adults with T1D, using the Behavior Change Wheel as a framework to inform future integrated care strategies. Methods: We conducted five online focus groups with 21 adults with T1D. Discussions were guided by a semi-structured guide, with questions on lived experience, accessibility of mental health treatment, and integrated service delivery informed by the COM-B model domains. Transcripts were analyzed using qualitative content analysis, whereby meaning units were open-coded and then deductively categorized into COM-B constructs of capability, opportunity, and motivation. Results: Participants described limited psychological capability to address mental health due to the heavy self-management burden of T1D, lack of knowledge about navigating care, and uncertainty about treatment interactions. Physical opportunities were constrained by fragmented systems, high costs, and competing responsibilities. However, co-located services and telehealth were viewed as facilitators. Social opportunity was shaped by stigma, isolation, and feeling burdensome, with peer communities providing critical support. Motivation was undermined by past traumatic encounters with psychiatric care and the burden of educating providers about diabetes, contributing to mistrust and avoidance of treatment. Conclusions: Findings highlight how capability, opportunity, and motivation interact to influence engagement with mental health care among adults with T1D. Addressing these barriers through tailored, integrated models of care may strengthen access, trust, and long-term treatment engagement. Full article

This article examines online hate as a driver of cyberbullying and a barrier to inclusive schooling, integrating theoretical, philosophical and methodological perspectives. We approach hate speech as communicative practices that legitimise discrimination and exclusion and, once amplified by social media affordances, erode equity, belonging and well-being in educational settings. The study adopts a qualitative, exploratory–descriptive design using focus groups with pre-service teachers from initial teacher education programmes across several Chilean regions. Participants reflected on the presence, trajectories and classroom effects of cyberhate/cyberbullying. Data were analysed thematically with ATLAS.ti24. Findings describe a recurrent pathway in which anonymous posts lead to public exposure, followed by heightened anxiety and eventual withdrawal. This shows how online aggression spills into classrooms, normalises everyday disparagement and fuels self-censorship, especially among minoritised students. The analysis also highlights the amplifying role of educator authority (tone, feedback, modelling) and institutional inaction. In response, participants identified protective practices: explicit dialogic norms, rapid and caring classroom interventions, restorative and care-centred feedback, partnership with families and peers, and critical digital citizenship that links platform literacy with ethical reasoning. The article contributes evidence to inform anti-bullying policy, inclusive curriculums and teacher education by proposing actionable, context-sensitive strategies that strengthen equity, dignity and belonging. Full article

Background: The digitalization of medical services is promoted as a solution for improving access, quality, and efficiency within healthcare systems. In this context, the study investigates the extent to which digitalization in Romania meets the current needs of patients through a convergent analysis of user perceptions and managerial perspectives. Based on the specialized literature, the research tests two hypotheses: (H1) the implementation of digital technologies significantly contributes to improving the quality of medical services and operational efficiency; (H2) digitalization has a positive impact on patient satisfaction by facilitating access to care and improving communication with medical personnel. Methods: The study adopted methodology is cross-sectional and mixed, including an online mixed-methods questionnaire for patients, distributed between 6 and 14 May 2025, and a qualitative questionnaire with open-ended questions distributed via e-mail to managers from public hospitals through The Administration of Hospitals and Medical Services of Bucharest, between 3 and 24 March 2025. Results: In total, 125 patients and 15 hospital managers participated in the study. Statistical analysis (χ², ordinal regression) and data triangulation highlight a predominantly positive, yet heterogeneous, patient perception of digitalization, with Hypothesis H1 only partially supported (weak, inconsistent, and in some cases negative associations between technology use and perceived service quality). By contrast, H2 was robustly validated, with patient satisfaction strongly linked to tangible benefits, particularly easier access and online appointment scheduling. However, use remains limited to administrative functions, while advanced technologies such as telemedicine or electronic health records are poorly adopted. From an institutional perspective, hospitals predominantly use IT systems for internal purposes, without real patient access to their own data, no interoperability between medical units, and marginal implementation of telemedicine. This reveals a significant gap between user perception and organizational realities, emphasizing the lack of a patient-oriented digital infrastructure. Conclusions: The results highlight the potential of digitalization to enhance patient experience and service efficiency, while also pointing out structural limitations that hinder the full realization of this potential. Patient satisfaction is strongly associated with tangible benefits, particularly easier access and online scheduling, whereas the effect on perceived quality is weaker and sometimes inconsistent. There are significant disparities in digitalization levels between healthcare providers, perceived by patients as public–private differences, and gaps among public hospitals are also confirmed by managerial data. These findings suggest that a successful digital transformation of the medical system in Romania must address both technological infrastructure gaps and organizational barriers, within a coordinated national strategy that ensures interoperability, patient-centered design, and sustainable implementation. Full article

This research presents a novel conceptual framework for inclusive education by integrating Internet of Things (IoT)-driven real-time environmental and behavioral monitoring with adaptive teaching strategies. Unlike traditional methods, our model leverages sensor-based data collection to analyze classroom conditions, teacher mobility, and student interactions, enabling dynamic adjustments that aim to enhance engagement and inclusivity. While the framework is theoretical and has not yet undergone experimental validation, we discuss how optimizing spatial configurations, voice dynamics, and movement patterns could support student participation, particularly for learners with diverse needs. Pilot implementations and empirical testing are planned for future research. By merging data-driven insights with educators’ expertise, our approach offers a scalable vision for creating responsive, inclusive learning environments that proactively address barriers to education. Full article

Driving-impairing medicines (DIMs) are associated with an increased risk of traffic accidents. While Dutch pharmacy staff are expected to counsel patients at the first and second dispense of DIMs, current practice suggests that second-dispense consultations are underutilized. This study explored pharmacy staff’s experiences and perceived barriers in addressing driving impairment during the second dispense. Qualitative, semi-structured interviews were performed with 17 staff members in community pharmacies across the Netherlands. Transcripts were coded using thematic analysis in Atlas.ti, applying both deductive and inductive coding strategies to explore current practices and improvement needs. Participants reported that they provided detailed information on medication use, side effects, and driving impairment during the first dispense. In contrast, driving fitness was only discussed during the second dispense when patients initiated the topic, which rarely happened. Barriers to discuss DIMs included time constraints, a lack of protocols or prompts in pharmacy software, limited privacy, and patients’ reluctance to communicate about this topic. Many pharmacy technicians relied on closed questioning and observed a lack of patient initiative. Facilitators included strong patient relationships, access to medical records, and a desire for training in consultation skills. Pharmacy staff expressed the need for improved protocols, better ICT (Information and Communication Technology) integration, and targeted communication tools to support safe use of DIMs. In conclusion, second-dispense consultations for DIMs are underused and can support patients in safer medication use. Improved implementation will lead to better-informed choices about medicines and driving, and strengthen the pharmacy’s contribution to traffic safety. Full article

Sales and marketing personnel are among the most knowledgeable individuals regarding the safety of the medications they promote. No previous work has assessed pharmaceutical sales and marketing personnel’s knowledge, attitude, practice (KAP), and barriers toward pharmacovigilance (PV) in Saudi Arabia; therefore, the present study aimed to assess these aspects and to scrutinize their associations with the subjects’ baseline characteristics. A validated questionnaire comprising five sections (baseline characteristics, knowledge, attitude, practice, and barriers) was disseminated via email networks and social media platforms between 18 March and 31 May 2025. All employees working in the sales and marketing departments of pharmaceutical companies in Saudi Arabia were eligible to participate. Participants’ responses were categorized as good or poor knowledge, positive or negative attitude, good or poor practice, and challenging or non-challenging work environment, based on the cumulative score in each respective section, using a 60% cutoff. A total of 400 participants completed the survey. Of these, about one-third (37.3%) had 2–4 years of professional experience and two-thirds (63%) were employed by multinational companies. Overall, 57% and 83.5% had good knowledge and positive attitude, respectively. The work environment was considered non-challenging by 92.8% of participants, and 61% reported good practice. We noted that holding a non-pharmacy degree was a significant predictor of poor knowledge and a challenging work environment. Additionally, employment in a local company was significantly associated with poor knowledge and practice. Pharmaceutical sales and marketing personnel in Saudi Arabia demonstrated acceptable levels of KAP and reported few barriers toward PV, with an opportunity for improvement. Full article

Background: Inclusion of under-represented rare-disease communities in research remains limited, threatening representativeness and equity. Methods: To assess equality, equity, diversity, and inclusion in research and identify barriers to participation faced by the rare disease community, utilising a mixed-methods online survey of a convenience sample of community advocates using Likert scales and free response options. Results: The findings from seventeen stakeholders in the rare disease community showed unanimous agreement that anxiety, fear, safety concerns, and lack of trust hinder participation in research. A total of 82% agreed or strongly agreed that additional financial resources are needed, and 76% agreed or strongly agreed that research grant applications often lack sufficient funds. The free-text responses demonstrate that the rare disease communities are keen to be involved in research but faces barriers to inclusion. Rare disease communities are willing to participate in research, but those responsible for research need to address the challenges related to language, misconceptions and fear. Conclusions: Key legislation in the United Kingdom, specifically the Proposed Patient and Public Involvement Strategy 2020–2025, emphasises the importance of involving patients and the public in health and social care. This survey marks the first step toward gaining valuable insights into the challenges faced by this community in participating in healthcare research, which is crucial for developing a solid evidence base for their treatment and care. Involving stakeholders is essential in health and social care policy and practice, rooted in advocacy and social justice. Full article

Background: Trismus is a frequent and debilitating complication in people with head and neck cancer (HNC), often arising after surgery or radiotherapy. Despite the key role physiotherapists play in rehabilitation, little is known about their perspectives and clinical approaches. This study aimed to explore physiotherapists’ experiences, perceptions, and treatment strategies in the management of treatment-induced trismus in HNC. Methods: A qualitative, cross-sectional study was conducted via a web-based self-administered questionnaire, developed in accordance with the CHERRIES guidelines. The survey combined closed- and open-ended questions across five thematic areas: sociodemographic, clinical experience, treatment practices, barriers, and medical devices. An inclusion algorithm ensured participation of physiotherapists with expertise in trismus. Quantitative data were analyzed descriptively; open responses underwent inductive thematic analysis. Results: Of 72 invited physiotherapists, 31 responded and 18 met inclusion criteria. Participants reported integrating manual therapy (100%) and therapeutic exercise (100%) into treatment, with more selective use of medical devices (77%). Barriers to implementation included lack of functional tools, dental status limitations, patient adherence issues, and socioeconomic constraints. Many highlighted that current devices often fail to mimic functional mastication, potentially overloading central incisors and limiting functional carryover. Conclusions: This qualitative study reveals limited device use, perceived design shortcomings, and the influence of dental status on functional recovery. Findings highlight the need for device innovation, interdisciplinary coordination, and protocols tailored to patient-specific barriers. Future research should explore combined approaches and include patient perspectives. Full article

Childhood, adolescent, and young adult cancer (CAYAC) survivors often face challenges entering the workforce due to long-term physical, cognitive, and psychological late effects, defined as chronic health conditions resulting from cancer and its treatments. This study evaluated a vocational integration programme that addresses these barriers and promotes psychosocial well-being. The multidisciplinary intervention combined career guidance, soft-skills training, and a paid internship. Using a mixed-method design with questionnaires and semi-structured interviews, we assessed feasibility, satisfaction, and psychosocial outcomes. Thirteen participants (mean-age-at-diagnosis: 12.9 years, SD 5.2; mean-age-at-interview: 27.2 years, SD 5.3) reported over 40 late effects, mostly of moderate severity. Health-Related Quality of Life (HRQoL), measured by the SF-12, showed a Physical Component Score mean of 45.2 (SD 9.1) and a Mental Component Score mean of 43.5 (SD 11.2), indicating greater psychological impact. The programme received high satisfaction ratings (mean 8.3/10) and was described as motivating and valuable, enhancing self-confidence and career prospects. Social support emerged as a key facilitator, while participants noted the need for flexibility and individualised pacing. Despite a limited sample size and potential recruitment bias, this study provides preliminary insights into the feasibility and perceived value of tailored vocational programmes, emphasising the importance of adaptable, socially supportive interventions for CAYAC survivors. Full article

The recent shift from in-person to digital pharmacy services is transforming how patients interact with their pharmacists but has the potential to disadvantage older adults (aged ≥ 65) who often face barriers when using technology. This study aimed to assess digital inequalities affecting medication access among older adults. A Spanish-language questionnaire was developed and psychometrically validated, revealing a two-factor latent structure comprising: (1) Technology Use, and (2) Medication Access. Item discrimination analysis confirmed that all significantly differentiated between those that used technology to facilitate their medication access and those that did not (p < 0.001). Participants with higher education reported greater income levels (p < 0.001), and income was in turn related to both internet access and digital skills. Age played a key role in perceptions of technology. Participants who considered technology helpful were younger ($\overline{x}$ = 72.9) than those who did not ($\overline{x}$ = 76.6; p = 0.001). There was no significant relationship between perceived technological usefulness and reporting not being able to acquire medications because of technological barriers (p = 0.788). This newly created and validated questionnaire identified gaps related to digital pharmacy services and may be a useful tool in future clinical, community, and investigative contexts. Full article