Search Results (368)

Background/Objectives: Loneliness is a major public health concern in later life and may be especially prevalent among older adults living in nursing homes. Evidence from Spain remains limited regarding modifiable correlates of different loneliness dimensions. This study aimed to describe social and existential loneliness among nursing home residents and examine their associations with sociodemographic, institutional, functional, and psychosocial factors. Methods: We conducted a cross-sectional study in Spanish nursing homes using face-to-face structured interviews with residents aged ≥65 years (n = 139). Social loneliness was assessed with the ESTE-II scale and existential loneliness with the existential loneliness subscale of the ESTE-R. Functional dependence was measured with the Barthel Index. Health literacy, locus of control, institutional variables, and suicidality-related items were also collected. Spearman correlations and multiple linear regression models with BCa bootstrapped 95% confidence intervals (5000 resamples) were used. Results: Social and existential loneliness were moderately correlated (ρ = 0.481, p < 0.001). Greater activity engagement was independently associated with lower social (B = −1.105, p < 0.001) and existential loneliness (B = −0.732, p = 0.029). Receiving visits regularly was associated with lower social loneliness (B = −4.083, p = 0.002), but not existential loneliness. Greater functional independence was associated with lower existential loneliness (B = −0.044, p = 0.023). Conclusions: Activity engagement was a consistent correlate across loneliness dimensions, whereas regular visits were mainly related to social loneliness and functional independence to existential loneliness. These findings support feasible long-term care strategies focused on meaningful activities, relational contact, and functional support. Full article

The relationship between financial literacy and capital market participation remains a central focus of both theoretical and empirical research in behavioral finance. However, existing research has predominantly relied on direct-effect, mediation, or moderation frameworks, thereby offering only a partial understanding of how individuals make investment decisions under uncertainty. To address this limitation, this study develops a sequential cognitive–affective framework by integrating the Theory of Planned Behavior (TPB) and the Risk-as-Feelings Hypothesis (RFH). Within this framework, investment intention is conceptualized as the outcome of cognitive evaluations and affective responses, with financial literacy influencing these processes by shaping perceived risk and institutional trust. Utilizing a multistage sampling strategy, survey data were collected from 449 individual investors and analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). The results indicate that financial literacy is positively associated with investment intention, both directly and indirectly through a sequential mediation pathway. Specifically, higher financial literacy is associated with lower perceived risk, which subsequently strengthens trust in financial institutions and ultimately increases investment intention. These findings suggest that financial literacy functions not only as a cognitive resource but also as a psychological mechanism that influences how individuals interpret and respond to financial uncertainty. By validating a sequential cognition–affect pathway, this study provides a more comprehensive behavioral explanation for the inconsistent findings reported in prior research. The findings further suggest that financial literacy initiatives designed to address risk perceptions and institutional trust may be more effective in promoting capital market participation than programs focused solely on information provision. Full article

Background: Health literacy plays an important role in medication understanding, self-management, and engagement with healthcare services among older adults. Limited health literacy may contribute to medication-related problems and reduced utilization of pharmacist-led services in geriatric populations. Methods: A cross-sectional, questionnaire-based survey was conducted among geriatric outpatients (≥60 years) attending a tertiary-care teaching hospital in Saudi Arabia. Health literacy was assessed using a four-domain functional tool—covering prescription label comprehension, understanding of healthcare instructions, confidence in completing medical forms, and comprehension of written health information—developed in alignment with established health literacy frameworks, including the Health Literacy Survey—European Union (HLS-EU) model and Baker’s conceptual framework. Participants were classified as having higher health literacy (0–2 domains impaired) or lower health literacy (3–4 domains impaired). Sociodemographic characteristics, clinical burden, medication self-management behaviors, and awareness of clinical pharmacist services were recorded. Multivariable logistic regression was used to identify factors independently associated with lower health literacy. Results: A total of 200 participants were included. Impairment in three or more domains was observed in 55.5% of participants. Lower health literacy was independently associated with older age, lower educational attainment, lower income, female sex, multimorbidity, and polypharmacy. Participants with lower health literacy reported higher rates of missed or incorrect medication dosing and unreported adverse drug reactions and lower use of medication management aids. Awareness of clinical pharmacist services and prior exposure to pharmacist counseling were significantly lower among participants with lower health literacy. Willingness to receive pharmacist counseling was higher among participants with higher health literacy and greater awareness of pharmacist roles. Conclusions: Health-literacy impairment is common among geriatric outpatients and is associated with medication self-management behaviors and engagement with pharmacist-led services. These findings highlight the relevance of functional health literacy in geriatric medication use and support further research on literacy-sensitive pharmacist-led interventions. Full article

This mixed-methods study examines how specific design features (SDF) in e-picture books influence phonological awareness (PA) and print knowledge (PK) among Chinese preschoolers. Ninety 5-year-old children were assigned to three groups: an e-picture-book group, a paper-book group, and a regular-preschool-program control group. All participants completed pretests of PA and PK, followed by a four-week reading intervention and post-tests. The quantitative results showed that the e-picture-book group significantly outperformed the control group in terms of PA, whereas no statistically significant differences were found between the e-picture book and paper-book groups or across groups regarding PK. Qualitative analyses of observations and semi-structured interviews further revealed two key mechanisms through which design features, such as pronunciation support, playback functions, and interactive hotspots facilitated children’s sensitivity to sound structures. In contrast, features intended to support PK (e.g., highlighted print) showed limited effectiveness, partly due to insufficient salience and the visual complexity of Chinese characters. These findings suggest that e-picture books may support phonological development in Chinese preschoolers, particularly through auditory and interactive design features, although no significant advantage was observed compared to narrated paper-book reading. However, their impact on print knowledge appears to depend on the alignment between design features and the characteristics of the Chinese writing system. This study highlights the importance of optimizing print-referencing features and incorporating instructional support to enhance early literacy outcomes. Full article

Against the backdrop of rapid digital acceleration and a tightening UK labor market, Small and Medium-sized Enterprises (SMEs) are pressured to move beyond manual administrative processes to bridge the national productivity gap. This study investigates how Human Resource Information Systems (HRIS) transform HR functions from administrative burdens into strategic assets within resource-constrained UK SMEs. Adopting an interpretivist, multiple case study qualitative approach, data were collected through semi-structured interviews with 12 HR managers across the hospitality, retail, and recruitment sectors and analyzed using thematic analysis via NVivo 14. The findings reveal a three-stage, non-linear pathway of value creation: administrative liberation through automation, strategic visibility via data-driven insights, and digital friction stemming from cultural and structural barriers. While HRIS enhances operational efficiency and evidence-based decision-making, its strategic value is mediated by organizational readiness, digital literacy, and change management capabilities. This research contributes to strategic human resource management literature by conceptualizing “digital friction” as a key mediating construct between technology implementation and value realization under resource poverty. For practitioners, it provides a deployment roadmap highlighting that managing the socio-technical “human element” is as critical as the core technological infrastructure for long-term competitiveness. Full article

Twice-exceptional students—those who are both gifted and have one or more disabilities—and gifted learners, more broadly, represent persistently underserved populations within educational systems. Gifted learners frequently encounter provision that does not adequately engage their potential, such as standardised approaches that neither recognise nor respond to their learning requirements. Traditional identification and programming approaches often rely on deficit-based approaches that pathologise neurodivergence and frequently neglect the complex, asynchronous learning profiles characteristic of twice-exceptional students. This article advances a functional alignment framework proposing that generative artificial intelligence’s processing patterns may align with the cognitive characteristics of some gifted and twice-exceptional learners. The proposed functional alignment spans five dimensions: conceptual movement, knowledge integration, topic continuity, working memory, and pacing and temporal flexibility; this positions GenAI as a potentially compatible interactive platform for personalised, strengths-based learning. The functional alignment framework is explicitly theoretical, advancing propositions rather than demonstrated effects, and requires empirical validation. Positioning GenAI as a mediating platform has the potential to disrupt longstanding barriers to evidence-informed educational provision for gifted and twice-exceptional students. Through examining the intersection of gifted education, special education, and educational technology, this theoretical work outlines a trajectory for the field, characterised by flexible, personalised, strengths-based approaches that can be responsive to the student in front of the teacher, instead of the all-too-often default to one-size-fits-all approaches. Critical considerations of equity, teacher capability, and ethical implementation are addressed, theorising that GenAI’s transformative potential may only be realised through deliberate, theoretically informed application grounded in deep understanding of learner neurodivergence and a proposed pivot from GenAI literacy to GenAI fluency. This work contributes to reconceptualising gifted education as inherently inclusive, responsive, and oriented towards actualising potential for gifted and twice-/multi-exceptional learners. Full article

Background/Objectives: Lung cancer is a leading cause of cancer-related mortality worldwide. As patients increasingly utilize large language models (LLMs) for health information, evaluating the readability and patient-centeredness of these tools is critical. This study aims to compare the performance of ChatGPT-4o mini, Microsoft Copilot, and Google Gemini in providing lung cancer information, focusing on their utility for individuals with limited health literacy. Methods: In this cross-sectional study (March 2026), 30 responses to ten standardized lung cancer-related queries were analyzed. Outputs were assessed using JAMA benchmarks and mDISCERN for quality, the SMOG index for readability, and PEMAT-P for understandability and actionability. Inter-rater reliability was analyzed using intraclass correlation coefficients (ICCs). Results: ChatGPT-4o mini demonstrated superior readability, achieving a sixth-grade level (SMOG: 6.23 ± 0.72, p < 0.001). Gemini achieved higher JAMA scores, indicating stronger academic rigour. While PEMAT-P scores were highest for ChatGPT (63.7%), all models exhibited moderate mDISCERN quality. Inter-rater reliability was excellent for JAMA (ICC = 1.000) and PEMAT-P (ICC = 0.883), though moderate for mDISCERN (ICC = 0.365), reflecting inherent interpretative subjectivity in qualitative assessment. No hallucinations were observed. Conclusions: Current LLMs exhibit a trade-off between accessibility and academic rigour: ChatGPT favours patient-friendly readability, while Gemini emphasizes structured content. The observed inter-rater variability in mDISCERN underscores the complexity of standardizing qualitative AI evaluation. These findings suggest that LLMs function best as complementary aids rather than substitutes for physician-led communication. Full article

Executive functions (EF)—including working memory, inhibition, switching, and processing speed—are central to children’s literacy development. Building on evidence that rhythm-based reading interventions strengthen EF and reading fluency, this longitudinal study examined whether a brief EF “warm-up” preceding visual rhythmic reading training (RRT) enhances reading outcomes in early elementary school. Thirty-four first-grade children (mean age = 6.7 years) were followed to third grade, when twenty-five completed an eight-week intervention combining EF games and visual RRT (three sessions per week). Pre- and post-intervention assessments included EF and standardized reading measures. Children showed significant gains in consonant, word, and contextual reading fluency and in naming speed. Greater improvements were associated with enhanced inhibition and switching skills following training. However, EF measured in first grade did not predict later reading gains, suggesting developmental changes in EF–reading relations. Findings highlight the role of EF in supporting fluent reading and suggest that incorporating short EF warm-ups before literacy instruction may enhance children’s readiness for learning and promote more efficient reading development in the early school years. Full article

Achieving carbon-neutral cities requires innovative strategies that integrate technological carbon capture, sustainable urban infrastructure, and proactive public engagement. While microalgae-based systems have shown promise for CO₂ sequestration and resource recovery, their scalability remains constrained by high costs and energy-intensive photobioreactor (PBR) designs. Here, we propose the retrofit of existing urban fountains into high-efficiency microalgae cultivation systems—microalgae-enhanced fountain landscapes—as an integrated solution that bridges ecological function and social outreach. This approach capitalizes on ubiquitous fountain infrastructure to minimize deployment costs, employs advanced fountain-style cultivation technology to enhance biomass productivity, and leverages strategic locations in high-footfall urban zones to actively elevate public carbon literacy and motivate low-carbon behavioral shifts through immersive engagement—a vital step toward city-wide participatory climate action. We critically analyze the feasibility of this system, highlighting its potential for multi-stakeholder value creation across developers, municipalities, and citizens. Furthermore, we synthesize recent advances in suspended microalgae cultivation, building-integrated PBRs, and microalgae-informed landscape design to contextualize the development pathway of fountain-based systems. By uniting technical efficiency with civic education, this work establishes a replicable framework for scalable urban deployment—simultaneously advancing carbon mitigation, public awareness, and circular resource flows in the transition toward climate-resilient cities. Full article

Digital isolation represents a contemporary paradox in which increased connectivity through social media and digital technologies does not necessarily translate into improved social integration or psychological well-being. This review synthesizes current evidence on the relationship between digital environments and mental health, with a focus on mechanisms underlying loneliness, anxiety, depression, and related outcomes. The findings indicate that problematic and passive use of social media—particularly when associated with social comparison processes and Fear of Missing Out (FoMO)—is consistently linked to increased levels of depressive symptoms, anxiety, sleep disturbances, and reduced well-being. At the same time, the evidence highlights substantial heterogeneity, suggesting that the impact of digital technologies is moderated by user characteristics, age, patterns of engagement, and psychosocial context. Importantly, digital technologies may also serve compensatory and protective functions by facilitating social support, especially in conditions of objective isolation. Key mediating mechanisms include cyberbullying, social exclusion, emotional contagion, and internalization of body image standards. The concept of “digital loneliness” emerges as a useful framework for understanding the discrepancy between constant connectivity and perceived relational insufficiency. Practical implications emphasize the need for targeted interventions focusing on digital literacy, healthy usage patterns, and psychosocial support rather than simplistic reduction in screen time. Overall, digital isolation should be conceptualized as a qualitative dysfunction of mediated social interaction rather than a purely quantitative effect of technology exposure. Full article

Smart tourism destinations, embedded by the internet and information and communication technologies, have been improving tourists’ experiences and connectivity. However, Destination Management Organisations (DMOs) still lack knowledge of how digital technologies can enhance their role and bring greater competitive advantage to destinations. In this sense, this study aims to develop an integrated smart tourism destination management ecosystem model that clarifies the relationships between digital technologies, managerial functions, benefits and implementation barriers within the broader smart city context. The study adopts a mixed-review design, combining bibliometric analysis and a systematic literature review. Bibliometric mapping was conducted using VOSviewer to analyse co-occurrence networks, thematic clusters and research trends. At the same time, the systematic review, with a systems thinking approach, enabled an in-depth qualitative examination of technological applications, managerial roles and governance implications. Data was gathered from 29 Scopus-indexed articles. The analysis identifies key benefits, including enhanced visitor experiences, improved decision-making and increased destination competitiveness, alongside persistent barriers related to governance, digital literacy, interoperability and cybersecurity. Based on these findings, the study proposes a conceptual ecosystem model that illustrates how DMOs can orchestrate digital technologies to support smart, sustainable and adaptive destination management. This research contributes to the smart tourism and smart cities literature by integrating bibliometric insights with a systems thinking perspective to develop a holistic destination management ecosystem model. Unlike prior reviews that address technologies or outcomes in isolation, this study offers a structured and actionable framework that advances theoretical understanding of smart tourism destinations while providing practical guidance for DMOs engaged in digital transformation. Full article

Background: Dietary interventions in heart failure (HF) remain limited, with current guidance focused largely on sodium restriction. Ketone metabolism has emerged as a potential therapeutic target in HF, with ketone supplementation shown to improve cardiac function. However, there are currently no studies investigating factors affecting adherence to a ketogenic diet (KD) in HF. Aim: To explore the factors influencing adherence to a KD in patients with HF to inform future dietary interventions. Method: This qualitative study was embedded within the KETO-HF pilot randomised controlled trial, in which participants with HF with reduced ejection fraction undertook a 4-month KD. Consenting participants were invited to complete semi-structured interviews. Interviews were audio-recorded, deidentified and transcribed verbatim. Data were analysed using thematic analysis with a mixed inductive–deductive strategy. Results: Fifteen participants were interviewed. Facilitators of adherence were: (1) personal motivation and self-regulation; (2) improved well-being; (3) interpersonal support and; (4) adaptive strategies and improved nutritional literacy. Barriers included: (1) early-phase physiological and psychological challenges; (2) social and cultural friction; (3) competing family and work demands and; (4) limited availability of suitable foods, particularly difficulty managing social situations and dining out. Conclusions: Adherence to a KD in people with HF is shaped by a combination of individual and social factors. These findings highlight the need for improved education, support, and increased food options to optimise implementation of dietary ketosis in HF. Full article

This study investigates the psychological and pedagogical architecture predicting environmental communicative agency among 304 primary school students (grades 5–6) participating in a climate change education programme. Aiming to bridge the persistent “knowledge–action gap” in sustainability education, the research identifies the cognitive, emotional, and instrumental pathways that transform children into active agents of low-carbon, pro-sustainability change in their everyday lives. Employing Structural Equation Modeling (SEM) with a latent climatic knowledge literacy construct, the analysis reveals that the latent construct of General Environmental Knowledge, comprising Conceptual Climate Knowledge and Relational-Systems Climate Knowledge, is the strongest direct predictor of Environmental Communicative Agency. Intrinsic curiosity emerged as a dominant driver of practical competence, while future-oriented tools function as the critical mediator between understanding and social action. Together, these mechanisms outline a school-based pathway through which climate literacy and motivation can be converted into household-level behavioural change and intergenerational climate resilience. The findings advocate for a paradigmatic shift from knowledge transfer to building operative sustainability agency, offering a pedagogical roadmap that fosters “constructive hope” and positions children as “trusted messengers” who catalyse intergenerational learning and reverse socialization toward more sustainable lifestyles. Full article

Background: Optimizing physical performance in youth football requires a comprehensive understanding of the interplay among behavioural factors, structural body composition, and functional cardiorespiratory capacity. While sports nutrition knowledge is hypothesized to influence athletic development, its concurrent relationships with regional body compartments and objective cardiopulmonary exercise testing (CPET) metrics remain poorly characterized in adolescent athletes. Methods: A cross-sectional study approach analysed body composition via bioelectrical impedance analysis (BIA), maximal cardiorespiratory testing, and sports nutrition knowledge evaluation using the Nutrition for Sport Knowledge Questionnaire (NSKQ). Structural associations and functional predictive capacities were analysed. Results: The cohort demonstrated an average VO₂max of 51.18 ± 16.67 mL/kg/min and a mean total nutrition knowledge score of 43.56 ± 18.06 out of 81 (53.8%). Total and domain-specific nutrition knowledge scores were not associated with body mass index (BMI), fat-free mass (FFM), or fat-free mass percentage (FFM%). Higher nutrition knowledge scores were independently associated with superior VO₂max and anaerobic threshold (AT) metrics. Exploratory geographic analyses revealed that rural-residing participants possessed significantly higher cardiorespiratory performance values and greater baseline nutrition knowledge profiles than their urban peers. Conclusions: In adolescent male football players, sports nutrition knowledge was not associated with static body composition measures but showed exploratory positive associations with selected cardiorespiratory fitness markers. These findings should be interpreted as cross-sectional and hypothesis-generating, as some potential confounding mediators were not assessed. These findings suggest that higher sports nutrition literacy may serve as a starting point for performance-supportive behaviours and metabolic conditioning, to some degree, warranting future interventional studies. Full article

Script reforms are socially motivated actions undertaken by institutions or communities that intentionally select, modify, or standardize writing systems. Although scripts are often analyzed as technical ways of writing, designed to enhance literacy and facilitate communication, this is not how script users typically perceive them. Beyond their linguistic function, scripts acquire deep social significance through their critically intertwined relations with issues of identity, political ideologies, and linguistic differentiation. This study analyzes such ideological underpinnings within script use and discusses the social ramifications of language codification. The study draws on different orthographic debates from Africa, Asia, and beyond, to demonstrate the social nature of script. The outcome of this study has implications for communities confronting orthographic decisions and competing script choices. Full article