Search Results (2,013)

Course selection presents a persistent challenge for students who often have difficulty articulating clear goals, integrating multiple considerations, and aligning academic choices with personal and professional aspirations. This study investigates whether concept mapping, as a metacognitive scaffolding tool, may shape how students interact with Generative AI (GenAI) systems during academic decision-making. In a randomized controlled experiment, 180 undergraduates at a polytechnic university in China were assigned to either a GenAI-only condition or a GenAI + Concept Map condition. After excluding 3 outlier participants, 177 students were included in the final analysis. Controlling for prior academic performance via ANCOVA, students with concept-map support showed different interaction patterns: they had a longer maximum consecutive-question chain within a session (GPA-adjusted means: 11.92 vs. 9.07 questions), formulated longer questions (15.27 vs. 11.93 words), and spent more time per conversation session on average (8.05 vs. 6.77 min). An analysis of conversation content showed that the concept-map group discussed a wider range of course selection factors (covering 4.46 vs. 3.66 main dimensions and 8.70 vs. 6.36 detailed factors). Epistemic Network Analysis further suggested that concept-map users linked different factors more frequently in their conversations, connecting academic requirements with career development, intrinsic interests, and external recognition in their discourse. Notably, these group differences remained after controlling for GPA in the ANCOVA models. These findings suggest that metacognitive scaffolding may reshape the way students engage with GenAI, with concept-map users shifting from brief exchanges to extended conversations covering multiple integrated factors related to their academic choices. Full article

Survivors of primary gastric lymphoma (PGL) face a significantly elevated and persistent risk of developing second primary malignancies (SPMs), with gastric adenocarcinoma representing the most frequent SPM and standardized incidence ratios reaching up to 16-fold above the general population. This excess risk persists for decades after initial treatment and is associated with increased cause-specific mortality compared to matched primary cancers. Among patients with PGL, approximately 5% develop gastric cancer (with two-thirds being metachronous), and nearly 15% harbor precancerous lesions including atrophic gastritis, intestinal metaplasia, and dysplasia. Beyond gastric malignancies, survivors also experience elevated rates of extra-gastric SPMs, particularly digestive system tumors (43%), respiratory cancers (21%), and urinary tract malignancies (13%). Key risk factors include treatment with immunochemotherapy or radiotherapy, advanced age, male sex, advanced stage at diagnosis, ulcerative-type lymphoma morphology, and persistent Helicobacter pylori (HP) infection. Patients receiving combined chemoradiotherapy demonstrate the highest SPM risk, particularly for gastric and pancreatic cancers. These findings underscore the critical importance of lifelong, risk-adapted surveillance strategies integrating both hematology and gastroenterology follow-up. Annual endoscopic surveillance is recommended for high-risk patients, with intervals adjusted according to lymphoma histology, HP status, and the presence of precancerous gastric lesions. Mandatory HP eradication with confirmation of response is essential for reducing gastric cancer risk. Future research priorities include prospective, standardized studies to better quantify SPM risk, validation of molecular and microbiological biomarkers for individualized risk stratification, and development of predictive models to enable personalized surveillance protocols and improve long-term outcomes in this vulnerable population. Full article

The perception of livability varies by individual, sociocultural, and environmental factors. Little is known about environment-livability relationships in unique sociocultural contexts with predominantly Mexican-origin Hispanic populations. This study examines how neighborhood environments relate to residents’ perceived livability in selected neighborhoods in El Paso, Texas, and potential differences between Hispanic and non-Hispanic samples. We surveyed 2233 residents and generated GIS (ArcGIS 10.6.1) measures of their neighborhood environments. The binary livability outcome was derived from a survey question about satisfaction with their neighborhood as “a good place to live.” Three logistic regressions were estimated using the full sample and two subsamples (Hispanic and non-Hispanic). For the full sample, significant (p < 0.05) environmental predictors included social cohesion, crime safety, attractive surroundings, sidewalk availability and maintenance, surveillance and night lighting, walkable destinations, and land-use mix; significant interactions existed between Hispanic ethnicity and gender, between Hispanic ethnicity and the density of sit-down restaurants, as well as between age and crime safety. Comparing two subsample models, environmental features and personal health status were more influential in the Hispanic subsample, whereas personal and household factors were more influential in the non-Hispanic subsample. Culturally responsive designs should prioritize the most critical environmental improvements to effectively enhance livability. Full article

Growing evidence indicates that the gut microbiota is a central regulator of systemic immunity, acting through epithelial barrier integrity, microbial metabolites, and bidirectional signaling with innate and adaptive immune cells. Within this framework, probiotics have attracted substantial interest as tools for immune modulation; however, their effects are not uniform and should not be generalized across species or formulations. This review synthesizes current evidence on the gut microbiota–immune axis and examines how defined probiotic strains influence immune homeostasis, inflammation, and clinical outcomes. Particular emphasis is placed on strain-specific effects among lactic acid bacteria, bifidobacteria, yeast probiotics, and emerging nontraditional candidates, with attention to mechanisms involving cytokine signaling, regulatory T-cell induction, nuclear factor kappa B (NF-κB) modulation, toll-like receptor (TLR) pathways, short-chain fatty acids (SCFAs), tryptophan metabolites, and bile-acid-dependent signaling. The available literature indicates that the most meaningful immunological effects arise from precisely characterized strains acting in specific host contexts, whereas inconsistent trial design, small sample sizes, variable dosing, and poor strain resolution continue to limit translation. Overall, current data support a shift from generic probiotic use toward mechanism-based, strain-specific, and increasingly personalized strategies for immune modulation. Full article

Rift Valley fever (RVF) is a viral zoonosis endemic in Madagascar, threatening human and animal health as well as the economy. Trade-related livestock movements are a major factor in the spread of RVF virus. While previous RVF research in Madagascar has focused on farmers or general ecology, this study is the first to specifically target livestock traders, the primary drivers for long-distance viral spread, in the Alaotra Mangoro endemic hotspot. This study aimed to assess the level of knowledge, prevailing attitudes and current practices regarding RVF among people engaged in livestock trade in the Alaotra Mangoro region, as well as the factors associated with these KAPs. A descriptive and analytical cross-sectional survey was conducted among 406 livestock traders in five districts of the Alaotra Mangoro region, using a structured questionnaire. A multi-stage sampling approach was employed, utilising purposive selection of markets followed by snowball sampling to reach informal traders often missed by traditional surveys. Generalised linear mixed models were used to analyse factors associated with KAPs regarding RVF. Awareness of RVF was very low (only 18.5% respondents had heard of it), with significant regional disparities (0% in Anosibe An’Ala versus 51.6% in Moramanga). Veterinarians (15.5%), family (12.8%), radio (9.6%) and neighbours (9.6%) were the main sources of information. Understanding of symptoms and modes of transmission (particularly mosquito bites) was limited. Higher levels of education (OR = 181.6; 95% CI: 29.9–1123.7; p < 0.001) and older age (50–60 years) were associated with better knowledge. Proactive attitudes were scarce (21.4%), although more than half (53.4%) believed that RVF is a real disease. Perception of personal risk and the contribution of livestock trade to the spread of the disease was low. However, confidence in animal vaccination was relatively high (60.3%). Preventive practices were highly inadequate. The majority did not wear protective equipment when handling sick animals (94.6%) and rarely avoided touching aborted foetuses (12.6%). Less than half (48.3%) expressed a willingness to report sick or dead animals, and nearly half admitted to having sold or purchased sick livestock (49.5%). Cooking meat (95.1%) and using mosquito nets (74.1%) were the only well-established practices. More than half of respondents (57.9%) lived more than 5 km from veterinary services, and cost was the most frequently cited barrier to consultation. Participation in awareness campaigns was virtually non-existent (5.4%). Results revealed critical gaps in KAP that may contribute to the persistence of RVF. A “One Health” approach is imperative, integrating human, animal and environmental health. Full article

Background/Objectives: Psychological resilience is associated with improved quality of life after stroke, yet less is known about how resilience and mindfulness interact over time in long-term recovery. This qualitative instrumental case study aimed to describe how psychological resilience and mindfulness unfolded in one stroke survivor with high psychological resilience and to identify processes that may inform future research on long-term stroke rehabilitation. Method: We conducted an instrumental qualitative case study involving a stroke survivor and his spouse (carepartner), using an in-depth interview framework for data collection and grounded theory procedures to support analysis. Data sources included interview transcripts and contextual artifacts, such as personal and professional websites, emails, and informal conversations. Findings: Three interrelated themes described how resilience unfolded in this case: (a) antecedents to poststroke resilience: personality traits, values, behavioral modeling, and environmental factors; (b) the obstacle is the way to posttraumatic growth; and (c) poststroke resilience: mindfulness embodied. Together, these themes suggest how prestroke strengths, responses to adversity, and mindfulness practice interacted in this participant’s long-term recovery. Conclusions: This exploratory case study offers a detailed account of how resilience and mindfulness may interact after stroke in one highly resilient individual. The findings are hypothesis-generating and may help guide future research on mindfulness-based and holistic approaches to long-term stroke recovery in larger and more diverse populations. Full article

Introduction/Objective: Patient satisfaction with nursing care quality is an important patient-reported indicator of hospitalization experience. Previous studies have mainly examined sociodemographic, clinical, and organizational factors, while personality traits have rarely been included in explanatory models. This study examined the association of sociodemographic characteristics, hospitalization-related variables, and personality traits with patient satisfaction. Methods: A single-center cross-sectional study was conducted among hospitalized patients in a general hospital in Croatia. Data were collected at discharge using a demographic and hospitalization questionnaire, the NEO Five-Factor Inventory, and the Croatian version of the Patient Satisfaction with Nursing Care Quality Questionnaire. Group differences were analyzed using non-parametric tests, and hierarchical regression analysis was performed. Results: Younger age, employment, male gender, and better self-rated health were associated with higher satisfaction. Patients admitted on a scheduled basis and those staying alone or with one other person in the room were more satisfied. Sociodemographic variables explained 21.5% of the variance in satisfaction (R² = 0.215; adjusted R² = 0.168). After hospitalization-related variables were added, the explained variance increased to 30.1% (R² = 0.301; adjusted R² = 0.232). The addition of personality traits further increased the explained variance to 45.6% (R² = 0.456; adjusted R² = 0.385). In the final model, staying with two or more persons was negatively associated with satisfaction, whereas agreeableness and conscientiousness were positively associated with satisfaction. Conclusions: Patient satisfaction with nursing care quality was associated with patient characteristics, hospitalization conditions, and personality traits. Accommodation conditions and individual psychological differences should be considered when interpreting satisfaction as an indicator of nursing care quality. Full article

Background/Objectives: Nursing organizational well-being has important implications for nurses, patients, and healthcare organizations. From a nursing-specific perspective, it arises from the balance between nursing demands and nursing resources in the work environment. However, most available instruments are not grounded in explicit nursing theory and do not allow the identification of well-being profiles through person-centered approaches. This study aimed to develop and evaluate the psychometric properties of the Nursing Organizational Well-being Questionnaire (NOW_Q). Methods: Following COSMIN guidelines, a two-phase design was adopted. Phase 1 involved item generation and expert evaluation, resulting in a 28-item instrument rated on a 5-point frequency scale. Phase 2 consisted of a multicenter cross-sectional study. Construct validity was examined through exploratory and confirmatory factor analyses using cross-validation. Reliability was assessed using ordinal omega coefficients, concurrent validity through associations with a global organizational well-being item, and cluster analysis to explore practical utility. Results: Findings (n = 461 nurses; 7 hospitals) supported an eight-dimension structure: workload, emotional demands, work–family conflict, autonomy, available resources, nurse–nurse relationship, nurse–head nurse relationship, and nurse–physician relationship. The confirmatory model showed good fit (RMSEA = 0.051; CFI = 0.938; TLI = 0.927; SRMR = 0.067), and all dimensions demonstrated satisfactory internal consistency (ordinal omega = 0.75–0.87). Significant associations with global organizational well-being were observed. Three distinct profiles emerged (Nurturing, Observed-Detached, and Withstanding), reflecting different configurations of nursing demands and resources. Conclusions: The NOW_Q is a theory-based, nursing-specific instrument with satisfactory psychometric properties and practical utility for identifying organizational well-being profiles and supporting targeted interventions in clinical settings. Full article

Excessive gaming (EG) is increasingly recognised as a modifiable behavioural risk among youth, with potential implications for mental health and well-being in digitally mediated environments. This study examines excessive gaming as a behavioural exposure and AI cyber-shielding (AI-CS) as a perceived digital protective factor among Generation Z university gamers. AI-CS is conceptualised as users’ perceived exposure to AI-enabled safety mechanisms embedded in gaming-related digital environments. The study investigates the associations of EG and AI-CS with four psychological outcomes: depressive symptoms (DEP), anxiety symptoms (ANX), hostile behaviours (HB), and personal well-being (PWB). Data were collected through a cross-sectional online survey of 983 university students aged 18 to 22 years from multicultural Middle Eastern backgrounds enrolled in Saudi universities. The sample included 54.2% males and 45.8% females. The proposed relationships were analysed using Partial Least Squares Structural Equation Modelling (PLS-SEM). The results show that excessive gaming is positively associated with depressive and anxiety symptoms and negatively associated with personal well-being. No significant association was found between excessive gaming and hostile behaviours. AI cyber-shielding is negatively associated with depressive and anxiety symptoms and positively associated with personal well-being, but it does not significantly predict hostile behaviours. These findings indicate that excessive gaming is primarily associated with internal psychological outcomes rather than external behavioural responses. They also suggest that perceived AI-enabled safety affordances in gaming-related digital environments are associated with lower psychological distress and higher well-being. The study contributes to research on digital well-being by introducing and empirically examining AI cyber-shielding as a perception-based environmental factor associated with psychological functioning among university students. Full article

Background/Objectives: Assessing population healthcare needs is essential for effective primary health care (PHC) planning; however, existing approaches often rely on biomedical or service-centered frameworks (i.e., approaches focusing on utilization patterns, clinical indicators, and provider performance metrics) that may not adequately capture the multidimensional and context-dependent nature of health needs. This study aimed to develop and validate the Primary Care Needs Assessment (PCNA) questionnaire, a participatory, multidimensional, and context-sensitive instrument for assessing perceived unmet healthcare needs and contextual determinants of health in community-based PHC settings. Methods: A sequential mixed-methods design was employed. In the qualitative phase, focus groups with PHC professionals and semi-structured interviews with community members informed item generation. The resulting questionnaire was administered to a sample of 817 participants recruited from community and primary care settings. Exploratory factor analysis (EFA) was conducted on a subsample (n = 520), followed by confirmatory factor analysis (CFA) on an independent subsample (n = 297). Internal consistency was assessed using Cronbach’s alpha. Results: EFA identified a 10-factor structure explaining 55.05% of the variance. CFA supported a refined 9-factor model with good fit indices (χ²/df = 1.675, RMSEA = 0.048, CFI = 0.92, TLI = 0.90, SRMR = 0.06). The instrument demonstrated satisfactory internal consistency (α = 0.76). Findings also highlighted unmet needs related to mental health, access to specialized services, and structural barriers (e.g., geographic distance, financial cost, limited service availability, and organizational constraints in accessing care), underscoring the multidimensional nature of health needs. Conclusions: The PCNA is a valid and reliable instrument that captures the complex interplay of individual, social, and contextual factors shaping health needs in PHC. By integrating community perspectives with psychometric validation, it provides a practical tool for supporting evidence-informed planning and more responsive, person-centered PHC systems (i.e., systems that adapt service provision to community-identified priorities and evolving population needs). Full article

(1) Background: This study investigated the characteristics and influencing factors of exposure to fine particulate matter (PM_2.5) and its chemical composition among elderly residents, with the aim of revealing potential differences in exposure. (2) Methods: A total of 258 elderly individuals were monitored for 72 h through individual, indoor, and outdoor PM_2.5 measurements. Concentrations were determined, and non-targeted components were analyzed by gas chromatography-mass spectrometry (GC-MS). Through Spearman correlation analysis, generalized linear model, and linear regression to explore the influencing factors. (3) Results: The individual PM_2.5 concentration was higher than both the indoor and outdoor concentrations. A total of 20,962 compounds were detected in personal PM_2.5 samples, 6794 in indoor PM_2.5 samples, among which 4285 compounds were shared between the two sample types. The components were mainly esters, aromatic compounds, and amines. PM_2.5 concentration was correlated with age, housing area, humidifier use, and second-hand smoke exposure. Chemical composition is related to outdoor pollution, furniture material, and daily behavior. (4) Conclusions: The individual PM_2.5 concentration is higher than the environmental concentration, and its chemical composition overlaps with the indoor and outdoor environment, which is jointly affected by demography, living conditions, and daily behavior. Full article

Personality-driven dialogue generation is essential for creating believable non-player characters (NPCs) in games. This study aims to (1) generate short NPC-like dialogue conditioned on predefined personality traits and (2) quantitatively evaluate whether the generated dialogue accurately reflects those traits. To achieve this, we propose a framework based on the OCEAN personality model for both controlled dialogue generation and systematic evaluation of personality consistency. We construct 32 personality configurations and generate responses to five scenario-based prompts using three models: Zephyr-7b, OpenChat-3.5-0106, and an Ollama-based OpenLLaMA-3B model. Personality consistency is evaluated using two complementary approaches: classification-based metrics (precision, recall, and F1-score) and score-based aggregation that measures alignment with intended personality traits. In addition, stability is introduced to quantify variability across multiple generated responses. The results suggest that the proposed framework supports a more structured comparison between high- and low-trait configurations within this controlled automated evaluation setting. OpenChat showed the highest performance in the automated evaluation, with F1-scores of 0.893 (high-trait) and 0.900 (low-trait), and the highest aggregated score of 340.94. Zephyr demonstrated strong stability (8.21) and consistent controllability, while the Ollama-based model showed lower consistency (F1: 0.715/0.743, score: 286.99) but substantially faster generation (0.57 s per response). Human validation on a representative subset supported the broad model-level tendency that OpenChat and Zephyr conveyed personality cues more clearly than Ollama, while the difference between OpenChat and Zephyr was less clear in human judgments. Full article

Chronic kidney disease (CKD) is characterized by persistent exposure to uremic toxins (UTs), many of which originate from gut microbial metabolism and contribute to renal, cardiovascular, and metabolic complications. Current evidence indicates that CKD is associated with dysbiosis and the enrichment of microbial taxa carrying genes involved in UT precursor production. Diet is a major modulator of the gut microbiota and therefore represents a promising lever to reduce UT generation in synergy with current nephroprotective therapies. Beyond simple protein restriction, more specific dietary approaches, particularly plant-based low-protein diets, appear especially relevant. Additional factors, including amino acid composition, lipid quality, food processing, constipation, transit time, meal timing, and circadian rhythms, may also influence microbial metabolism and UT production. This review examines the role of nutrition in shaping the gut microbiota–UT–kidney axis and discusses how dietary modulation may support precision nutrition in the context of CKD. It also highlights future directions based on multidimensional phenotyping and robust biomarkers to capture interindividual variability, guide personalized interventions, and ultimately improve renal and cardiovascular outcomes in CKD. Full article

Background: Diabetes mellitus (DM) management is influenced by both physiological and psychosocial factors. Personality traits and psychiatric symptoms may affect glycemic control, but their exact relationship remains unclear. This study aimed to evaluate the association between glycemic control, personality traits, and psychological symptoms such as depression, anxiety, and stress in patients with DM. Methods: A total of 174 adult patients with Type 2 DM (T2DM) were included. Glycemic control was assessed via HbA1c values over one and five years. Personality traits were measured using the Personality Belief Questionnaire-Short Form (PBQ-SF), and psychiatric symptoms were evaluated with the Symptom Checklist-90-Revised (SCL-90-R). Patients were grouped based on HbA1c levels: good (<7%), moderate (7–9%), and poor (>9%) control. Results: Significant differences were found in several personality traits, including obsessive-compulsive, histrionic, paranoid, passive-aggressive, antisocial, and schizoid traits, between groups, with higher scores in patients with moderate glycemic control compared to those with poor control. No significant relationship was observed between psychiatric symptoms and glycemic control. The proportion of patients meeting the predefined HbA1c follow-up frequency threshold was lowest in the poor control group. Conclusions: General psychiatric symptoms did not show significant differences across glycemic control groups. Several maladaptive personality traits differed between groups in univariate analyses; however, after adjustment for potential confounders, only passive-aggressive personality traits remained independently associated with HbA1c levels. These findings indicate a possible association between specific personality characteristics and glycemic control, although no direct clinical utility can be inferred from the present data. Further longitudinal studies are required to clarify these relationships. Full article

Background: This study sought to appraise health-related quality of life (HRQoL) one year after admission in persons with digestive cancer and chronic digestive diseases, stratified by nutritional status on hospital admission, and to identify clinical predictors of HRQoL. Methods: HRQoL questionnaires were completed on admission and after 12 months by a prospective cohort of 560 persons with digestive cancers and digestive chronic diseases. Between 2020 and 2021, among the 926 patients admitted to the study, a prospective cohort of 560 persons with digestive cancers or digestive chronic diseases completed HRQoL questionnaires at admission and after 12 months. Nutritional status was assessed using MUST and GLIM criteria. Multiple correspondence analyses were used to identify clinically meaningful subgroups of patients. Multivariate analyses were performed to identify HRQoL predictors. Results: Participants had a mean age of 63.4 years; 60.7% were male and 39.3% female. At baseline, 34.81% of participants were classified as malnourished. Scores for mental health (SF-36 MH), role-emotional (SF-36 ER), and vitality (SF-36 VT) were significantly lower among persons with severe malnutrition and colorectal cancer (CRC) (p = 0.001, p = 0.004 and p = 0.009, respectively). Regarding changes in HRQoL over one year, persons with severe malnutrition at baseline showed the greatest improvement in mental health (SF-36 MH) within the CRC group (p = 0.01). Among persons with cancer, polypharmacy was consistently associated with poorer outcomes, with significant negative associations across EuroQoL (p < 0.001), SF-36 Social Functioning (p < 0.001), and General Health (p < 0.001). In persons with digestive diseases, length of admission was inversely associated with Physical Role (p < 0.05) and Body Pain (p < 0.05). Finally, GLIM status displayed limited associations, only significant in the case of Vitality and Body Pain (p < 0.05 in both). Conclusions: HRQoL in patients with oncological and digestive diseases is shaped by a complex interplay of clinical and sociodemographic factors. Full article