Search Results (2,672)

Background/Objectives: The role of middle nurse managers is characterized by high levels of responsibility and complex relationships, which can generate significant stress and put their mental health at risk. A mixed-methods study was carried out to measure distress and work-related factors among Italian middle nurse managers and to explore their experiences in order to identify critical issues and possible actions for improvement. Methods: The study was conducted between October 2019 and January 2020. Results: In the quantitative phase, 65 middle nurse managers completed validated questionnaires on distress, perceived health, working environment, job satisfaction, and emotional workload. Although most participants reported feeling healthy, nearly 30% experienced distress ranging from mild to severe. These findings informed the qualitative phase, in which 10 middle nurse managers were interviewed to further explore the lived experiences. Qualitative analysis identified four main themes: (1) sources of stress at work; (2) the importance of personal and organizational support for middle nurse managers; (3) copingstrategies; (4) actions for change to improve work activities. All themes were further divided into sub-themes. Middle nurse managers report experiencing difficulties in their work, adopting strategies to adapt to everyday challenges, and expressing a need for support to improve the management of their work teams. Conclusions: The findings suggest that, despite generally positive well-being indicators, a substantial subgroup of middle nurse managers experience distress related to organizational constraints. Practical implications include strengthening organizational support, reducing excessive workload, and addressing staffing issues to better sustain middle nurse managers’ well-being. Full article

Background: Family-based interventions are effective in mitigating the risk for relapse of schizophrenia. However, the accessibility of these interventions is scarce in many clinical settings. A group-based brief cognitive behavioural intervention facilitated by a therapist using videoconferencing may help address this practice gap and improve the high treatment disengagement that occurs in interventions delivered in self-paced web-based forums or mobile applications. Objective: To examine the feasibility, acceptability, and safety of an online group-based cognitive behavioural family intervention for dyads of individuals with schizophrenia-spectrum disorders and caregivers. Methods: This feasibility study adopted a parallel-group, assessor-blind randomised controlled trial with a twelve-week post-intervention follow-up as well as individual semi-structured interviews. Participants were randomly assigned to the intervention group [i.e., tele-group cognitive behavioural family intervention (tgCBFI) group] and the treatment-as-usual group. Both groups also received biweekly brief telephone support. The feasibility and acceptability were assessed by the recruitment rate, intervention completion rate, retention rate and participants’ service satisfaction. Safety was measured by the number of adverse events. Results: Most intervention group participants (85.7%) attended all six online group sessions (six service user-caregiver dyads, corresponding to 12 participants), while 100% of participants attended the per-protocol number of sessions (≥four sessions). The study recruitment rate was 16.4%, while the study retention rate for follow-up assessments was 95.8%. No adverse events were reported throughout the study. Five themes were generated to illustrate the benefits of and recommendations for the tgCBFI programme to complement the quantitative findings. Conclusions: The preliminary results suggested that the use of videoconferencing to deliver group-based cognitive behavioural intervention was partially feasible and provided exploratory estimates suggesting possible improvement in psychiatric symptoms for individuals with schizophrenia-spectrum disorders, warranting a fully powered trial. Trial Registration: prospectively registered at ClinicalTrials.gov NCT05808244. Full article

Background: Post-COVID-19 Condition (PCC) causes persistent multisystem symptoms, reduced quality of life, and high healthcare needs. Data on patient experiences in Switzerland are scarce. Objective: To assess healthcare access, treatment pathways, waiting times, and insurance-related burden among individuals with PCC in Switzerland. Methods: We conducted a nationwide anonymous online survey between July and October 2025. Adults living in Switzerland with symptoms persisting ≥12 weeks after SARS-CoV-2 infection were eligible. Recruitment was conducted through support groups, social media, and specialized PCC consultations at several Swiss hospitals. The multilingual questionnaire covered demographics, symptoms, healthcare utilization, treatment experiences, and insurance issues. Results: A total of 333 individuals participated (81.7% women; mean age 45.8 years). The most frequent symptoms were fatigue (98.5%), brain fog (92.5%), post-exertional malaise (91.0%), sleep disturbances (82.3%), and musculoskeletal pain (80.8%). Only 12.6% reported early and adequate medical support, whereas 45.0% had to actively seek care themselves and 24.6% had received no support. General practitioners were the most frequently consulted providers (77.5%), followed by specialized PCC clinics (39.0%). Waiting times were prolonged: 32.1% waited 4–6 months, 32.4% >6 months and 10.8% reported no available consultation service. Satisfaction with care was modest (3.02/5). Difficulties with social insurance were reported by 42.6%, including missing benefits, lack of recognition, and prolonged procedures. Conclusions: Individuals with PCC in Switzerland face major barriers to timely and coordinated care. Strengthening primary care competencies, expanding multidisciplinary services, and implementing structured patient-centered pathways are urgently needed to improve outcomes and reduce long-term disability. Full article

Background/Objectives: Baby-Led Weaning (BLW) is an increasingly adopted complementary feeding approach in which infants self-feed family foods rather than being spoon-fed purées. Caregivers’ attitudes play a central role in its adoption and implementation, yet no validated instrument has been specifically designed to assess caregivers’ attitudes toward BLW. This study aimed to develop and psychometrically validate the BLW Caregiver Attitudes Scale (BLW-CAS). Methods: A methodological psychometric study was conducted in two phases. Scale development involved a literature review, expert panel evaluation, and cognitive pretesting with caregivers. Psychometric validation was conducted among 256 caregivers, while temporal stability was assessed in an independent test–retest sample of 92 caregivers. Content validity, internal consistency, temporal stability, construct validity, and convergent validity were examined using established psychometric methods. Results: The final 16-item BLW-CAS comprised three dimensions: Predisposition, Self-efficacy, and Practical Skills. The revised scale achieved an S-CVI/Ave of 0.93. The three-factor exploratory solution accounted for 67.46% of the total item variance. The three-factor CFA model showed good overall fit (CFI = 0.995; TLI = 0.994; RMSEA = 0.052; SRMR = 0.066). Internal consistency was acceptable to excellent across subscales (α = 0.757–0.913; ω = 0.807–0.953), and test–retest reliability was good (ICC = 0.832). Positive small-to-moderate correlations with general self-efficacy (r = 0.298) and decision satisfaction (r = 0.350) supported convergent validity. Conclusions: The Spanish BLW-CAS is a concise, multidimensional instrument with promising psychometric properties for assessing caregivers’ attitudes toward BLW, supporting future research and the evaluation of interventions related to complementary feeding practices. Full article

Background and Objectives: Ultrasound-guided sciatic and saphenous nerve blocks are widely used as analgesic alternatives for multimodal analgesia. However, how to objectively quantify the opioid- and anaesthetic-sparing effects of an additional peripheral nerve block in patients undergoing ankle fracture surgery under general anaesthesia remains unclear. This study aimed to evaluate their efficacy in managing postoperative pain and opioid-sparing effects following ankle fracture surgery. Materials and Methods: Patients scheduled for ankle fracture surgery were randomly assigned to the nerve block (n = 30) or control group (n = 30). The primary outcome was the postoperative numeric rating scale (NRS) score. The secondary outcomes included the total doses of remifentanil and propofol, Quality of Recovery-40 Korean (QoR-40K) scores, and self-reported patient satisfaction. Results: The NRS score immediately after surgery was significantly lower in the nerve block group compared with that in the control group (2.6 ± 2.5 vs. 6.2 ± 2.6; p < 0.001). The total remifentanil dose required during surgery was also significantly lower in the nerve block group than in the control group (1148.1 ± 391.8 vs. 1487.4 ± 798.8; p = 0.041). However, the patient satisfaction scale (3 [IQR, 2–4] vs. 3 [IQR, 2–4]; p = 0.206) and QoR-40K score 24 h after surgery (169 [IQR, 155–184] vs. 175 [IQR, 154–165]; p = 0.324) did not differ significantly between the two groups. Conclusions: Ultrasound-guided sciatic and saphenous nerve blocks significantly reduced immediate postoperative pain and intraoperative remifentanil consumption under qNOX (quantitative nociception index)-guided general anaesthesia during ankle fracture surgery. Full article

The Michelangelo phenomenon describes an interpersonal model of personal growth in which romantic partners affirm each other’s ideal selves, thereby enhancing their relational and personal well-being. The present study examined how attachment security relates to this process. Based on cross-sectional data from N = 452 individuals in 258 couples, the results replicated prior work and provided new insights. Greater partner affirmation was associated with higher relationship quality, higher life satisfaction, and lower depression, but was not associated with general anxiety. Movement toward the ideal self mediated the links between partner affirmation and well-being outcomes. Importantly, attachment security (lower attachment anxiety and avoidance) was directly associated with greater partner affirmation and indirectly associated with greater well-being outcomes through partner affirmation and movement toward the ideal self. The effects were particularly robust for lower attachment anxiety, relative to lower attachment avoidance. The findings suggest that attachment security may allow individuals to better rely on close relationships to experience personal growth. Full article

This study examines NPC dialogue mechanisms as an independent design factor in task-oriented digital games. Although generative NPCs are often discussed in relation to narrative richness, conversational naturalness, and social presence, limited controlled evidence exists on whether dialogue mechanisms themselves affect player outcomes when task information is held constant. To address this gap, the study combined a formative user study with a single-factor between-subject experiment using a controlled game prototype. The LLM-NPC and Script NPC conditions shared identical task goals, scene structure, completion criteria, predefined fact set, and task-stage prompting boundaries. The experimental contrast was therefore framed as a comparison between a script-based branching dialogue interface and a boundary-controlled LLM-based adaptive dialogue interface, rather than as a comparison involving unequal task information. The results showed that, under controlled information boundaries, LLM-NPCs significantly improved task efficiency, as reflected in shorter completion time, fewer NPC inquiries, and fewer incorrect searches. For immersion, the overall multivariate effect was not statistically significant, and no confirmatory evidence of an LLM-NPC advantage in immersion was found. For satisfaction, the LLM-NPC condition showed significantly higher total satisfaction, which was specified as the primary satisfaction endpoint. Secondary affective and overall evaluative satisfaction outcomes showed consistent uncorrected differences in the same direction. These findings suggest that, under the implemented factual and procedural controls, the value of LLM-NPCs in this task-oriented setting is less likely to lie in providing more information than in reorganizing predefined task facts in a more context-sensitive and player-adaptive manner. Boundary-controlled adaptive dialogue may therefore provide a useful design perspective for future task-oriented NPC systems. Full article

Background: Previous research has documented generational differences in life satisfaction and work-related attitudes, but less is known about how work and life satisfaction differ within parent–child dyads. This preregistered study examined work satisfaction, life satisfaction, core self-evaluations, personal values, and financial situation among working young adults and their working parents in Poland. Methods: The study used a preregistered, cross-sectional, observational parent–child dyadic design. The final analytic sample consisted of 87 complete dyads, corresponding to 174 individual participants. Parent–child responses were linked using anonymised self-generated codes. Group differences in work satisfaction, life satisfaction, and core self-evaluations were tested using paired Yuen’s trimmed t-tests. Preregistered predictors of work satisfaction and life satisfaction were tested using linear mixed-effects models with dyads as a random intercept. Results: Parents reported higher work satisfaction and higher core self-evaluations than their young-adult children, whereas the expected group difference in life satisfaction was not supported. Core self-evaluations positively predicted work satisfaction, whereas the preregistered financial situation composite and achievement value did not. A supplementary component-level analysis showed heterogeneous associations among the individual financial indicators. Work satisfaction was positively associated with life satisfaction, whereas the preregistered Schwartz values were not significantly associated with life satisfaction. Conclusions: The findings suggest that parent–child differences in satisfaction-related outcomes are more visible in work satisfaction and core self-evaluations than in global life satisfaction. Core self-evaluations emerged as the most consistent psychological predictor of work satisfaction. The value-based hypotheses were not supported, although these null findings warrant caution because several brief PVQ scales had low reliability. Full article

Preserving non-renewable geological assets for future generations requires balancing physical geoconservation with engaging public outreach. Digital twins provide an excellent method for protecting delicate geological specimens. Unfortunately, traditional on-site interactive displays rely on expensive, high-maintenance proprietary hardware that small museums can rarely afford. This study introduces GYRO3DSCOPE, a free, multi-tenant Bring Your Own Device (BYOD) platform built to widen public access to digital collections. Scanning a dynamic QR code lets visitors use their own smartphones as remote spatial controllers. This allows them to rotate and manipulate high-fidelity 3D models in real time without downloading or installing local apps. The system is an open-access aggregator, enabling curators to stream site-specific content directly from existing repositories like Sketchfab or 3DBigDataSpace. The platform was evaluated at the Geology Museum of the “Alexandru Ioan Cuza” University of Iași (Romania) during the May 2026 Night of Museums public exhibition. The installation featured a collection of 149 digital twins of rocks, minerals, and fossils. Automated tracking across 276 unique visitor sessions showed excellent engagement, recording an average dwell time of 91.3 s and a user satisfaction score of 4.9 out of 5.0. This approach gives underfunded venues an affordable, scalable tool to encourage public engagement with geosciences and complement the sustainable management of ex situ geoheritage collections without adding maintenance liabilities. Full article

Against the backdrop of population aging, the well-being of older adults with disabilities in daily life and its underlying mechanisms has increasingly become an important research topic. Using data from the 2020 wave of the China Health and Retirement Longitudinal Study (CHARLS), this study focuses on 509 individuals aged 60 and above with disabilities. It incorporates informal social support, depression risk, and life satisfaction into a unified analytical framework, and employs ordered Logit models, binary Logit models, and the KHB decomposition method to examine their interrelationships and underlying mechanisms. The results show that: (1) informal social support is positively associated with the life satisfaction of older adults with disabilities; (2) informal social support is negatively associated with depression risk; and (3) depression risk is negatively associated with life satisfaction and plays a significant mediating role in the relationship between informal social support and life satisfaction, accounting for 23.25% of the total effect. From a daily life perspective, this study reveals that the well-being of older adults with disabilities is not solely derived from institutional resource provision, but is generated and sustained through ongoing social interactions and relational networks. The study therefore deepens our understanding of the everyday and relational dimensions of subjective well-being in later life. Full article

Background and Objectives: Achieving a postoperative refractive outcome close to the target is crucial in cataract surgery, as residual refractive errors can affect visual quality and patient satisfaction. Methods: This study evaluates the relationship between preoperative target refraction, postoperative intraocular lens (IOL) shift, and refractive stability. Prospective, observational study conducted at the Clinical Hospital Centre Sestre Milosrdnice, Zagreb, Croatia, involving patients undergoing routine cataract surgery with monofocal IOL implantation. Ninety-four eyes undergoing phacoemulsification with implantation of one of three monofocal IOLs (PCB00, RayOne HA, Akreos Adapt) were included. Preoperative biometry assessed axial length, anterior chamber depth, central corneal thickness, and white-to-white distance. Target refraction was −0.75 to 0.00 D. IOL position and refraction were measured at 1 week, 1 month, and 6 months postoperatively. Patient satisfaction was evaluated at all three time points. Results: All three IOLs demonstrated comparable in-the-bag stability over 6 months, with minimal longitudinal shift (all p > 0.05). Postoperative refractive outcomes were generally comparable, but RayOne HA showed a slightly more myopic deviation, whereas PCB00 and Akreos Adapt remained closer to emmetropia. The differences reflect the extent of deviation from the intended postoperative refraction, with statistically significant intergroup differences at 1 month (p = 0.004) and 6 months (p = 0.045). Conclusions: All three IOLs provided stable positioning and excellent visual outcomes. However, small differences in refractive predictability suggest that IOL design may influence the accuracy of target refraction. Tailoring target refraction according to IOL type may improve the likelihood of achieving emmetropia and optimize patient satisfaction. Full article

Interventions aimed at improving the psychological well-being of Deaf and Hard-of-Hearing children have been overlooked. This study aimed to develop a targeted picture-book-focused, multi-component psycho-emotional support intervention for Deaf and Hard-of-Hearing children and to evaluate its feasibility and acceptability. A mixed-methods design based on the Successive Approximation Model (SAM) was used. A user-centered picture book was developed and evaluated through a multi-component intervention involving 76 Deaf and Hard-of-Hearing children. Quantitative data were collected at baseline (T0) and one-month follow-up (T1) using the Children’s Loneliness Scale, the General Self-Efficacy Scale, and the Adolescent Mental Resilience Scale. Focus group interviews explored acceptability and appropriateness. Five empowering components were identified, which guided the development of the picture book. The recruitment rate of the study was 92.7% (76/82). A total of 68.4% (52/76) of participants completed the intervention and follow-up. The adherence rate was 92.3% (48/52). Most participants (88.5%, 46/52) reported satisfaction with the intervention. Exploratory changes were observed for loneliness (IQR 41.5 vs. 39.0; 95%CI: 0.275, 0.723) and self-efficacy (IQR 24.0 vs. 25.0; 95%CI: −0.577, −0.027), while resilience showed no significance (IQR 85.0 vs. 87.0; 95%CI: −0.176, 0.435). Most participants rated the picture book as acceptable and were willing to share it. The intervention appears acceptable, feasible, and appropriate, supporting the need for a randomized or implementation study. Full article

Sustainable tourism in oasis landscapes requires governance approaches that go beyond generic destination-growth models and standardized sustainability checklists. In living cultural landscapes such as Al-Ahsa Oasis, tourism development is inseparable from water systems, palm-grove agriculture, rural livelihoods, heritage values, climate stress, visitor behavior, and institutional accountability. This paper develops a governance framework for sustainable tourism in Al-Ahsa Oasis, Saudi Arabia, a UNESCO World Heritage cultural landscape. Methodologically, it is a conceptual framework-development study based on structured critical review and contextual synthesis. It critically interprets international sustainable tourism, heritage management, visitor management, and sustainable investment frameworks in relation to recent Al-Ahsa-specific evidence on rural tourism, resident satisfaction, farm-tourist behavior, rural lodges, land-cover change, and World Heritage governance. The study proposes a six-dimensional framework structured around cultural landscape stewardship, water-sensitive ecological governance, agricultural landscape continuity and rural accommodation regulation, community benefit and local enterprise, climate-responsive visitor management and interpretation, and monitoring and institutional accountability. These dimensions are treated as interdependent governance fields rather than separate checklist categories. The framework is further operationalized through an indicator and governance matrix linking suggested indicators, data sources, governance mechanisms, and responsible actors. The paper contributes by reframing sustainable oasis tourism as an adaptive governance problem rather than a technical exercise in applying predefined criteria. It provides an evidence-informed basis for planning, monitoring, stakeholder deliberation, policy refinement, and future empirical testing in Al-Ahsa and comparable arid cultural landscapes. Full article

The study aimed to develop and preliminarily evaluate a multidimensional model and questionnaire for assessing domains of patient satisfaction with dental services in the context of Polish dental care. Analyses were based on data collected in a cross-sectional online survey conducted among 336 patients. Confirmatory factor analysis supported an eight-factor structure comprising dentist-patient communication, dentist’s sensitivity to patient pain, professional competence, trust in the dentist, availability of services, dental clinic equipment, dental clinic location, and value of services. The model showed acceptable fit to the data and provided evidence of convergent and discriminant validity, with all HTMT values below the recommended threshold of 0.85. The final questionnaire comprised 32 items organised into eight four-item scales, which showed acceptable-to-high internal consistency. Structural equation modelling revealed a pattern consistent with a statistical mediation model in which general satisfaction links evaluations of specific domains of dental services with revisit intention. These findings support the usefulness of the proposed multidimensional model for assessing patient satisfaction with dental services, although further validation in independent samples is needed to confirm its temporal stability, measurement invariance, predictive validity, and generalizability. Full article

As China shifts from expansion-oriented urbanization to stock-based renewal, cities need diagnostic tools that can identify built-environment deficiencies and translate them into spatially targeted renewal priorities. Building on China’s official urban physical examination system, this study develops a land-renewal-oriented diagnostic workflow across four spatial scales: housing, community, block, and urban area. The framework integrates top-down objective assessment of land, facilities, infrastructure, environment, and safety conditions with bottom-up resident satisfaction evaluation. It then converts composite health scores, problem concentration, and safety relevance into three renewal priority categories: Priority Level III (critical renewal), Priority Level II (general renewal), and Priority Level I (long-term optimization). Using Wu’an, a resource-dependent county-level city in Hebei Province, as a case study, the results show that Priority Level III problems are concentrated mainly at the housing scale, especially corridor safety hazards, while widespread pipeline aging and age-friendly retrofitting needs are classified as Priority Level II medium-term renewal issues. Community and block scales mainly show facility, governance, and functional mismatches. The contribution of this study is not the four-tier scale structure itself, which is derived from existing policy, but the operational translation of urban physical examination results into spatial diagnosis for land renewal, renewal priority classification, and action-plan formulation. The workflow offers a transferable methodological reference for county-level stock renewal, while local indicators, thresholds, and implementation pathways require contextual adaptation. Full article