Search Results (2,571)

The global water situation is deteriorating not only due to the progressing climate change but also to irrational consumer behaviors, which are driven by attitudes. Given the above, it seemed essential to identify attitudes toward the issue of access to freshwater in households, considering sustainable development guidelines. The aim of this study was, therefore, to develop a research tool for the identification of respondents’ attitudes toward this problem and then to determine its validity and reliability. The object of the study was an original questionnaire serving as a research tool for identifying the specified attitudes. The data required for this study were acquired through a critical review of the literature and a questionnaire survey method. The study was conducted in one of the Polish urban agglomerations using the Paper-and-Pencil Interviewing (PAPI) technique. An in-depth analysis of the validity and reliability of the tool, carried out using a statistical procedure, confirmed it to be a viable means to identify these attitudes in Poland. Therefore, there are reasonable grounds to assume that, following the application of the procedure presented in this manuscript, the developed tool may also be used to identify the specified attitudes when implemented in a different population. Full article

The impact of the built environment on physical and mental health and wellbeing has been evidenced worldwide. Quality and design affect residents’ wellbeing and physical and mental health outcomes. A local authority planning team in London introduced new guidance to improve the quality of amenity space within residential developments. This paper aims to evaluate the early implementation of this guidance using Normalisation Process Theory. A qualitative design was employed using semi-structured interviews (n = 34), with a purposive sample of planning staff, applicants, review panel members and organisers and elected officials. Framework analysis was undertaken. All stakeholders perceived the introduction of the new amenity space guidance positively, but views of the planning officer training that accompanied it were more nuanced. Key factors influencing implementation included attitude towards and understanding of the new guidance, use of common language, workload, number of policy and guidance documents and a lack of a guidance template from the beginning. Further contextual barriers included the need for economic viability for developers and affordable housing in the area. To further embed and sustain implementation, it is recommended that the guidance continues to be used in a flexible manner with ongoing training and focused support for both planning officers and planning applicants. Full article

Objective: To analyze the perceived facilitators and barriers promoting and hindering the clinical application of the best evidence of clean intermittent catheterization (CIC) in patients after radical hysterectomy (RH). Methods: This study employed a convergent parallel mixed-methods design. Participants included patients undergoing CIC after RH, medical and nursing practitioners and managers in the gynecological department and outpatient clinics at a tertiary-level women’s and children’s hospital in Chengdu. They were included in both components separately. Interview data were managed using Nvivo 11.0 software and analyzed through directed content analysis. Quantitative data were analyzed using SPSS 29.0 statistical software. Results: A questionnaire survey was conducted among 156 healthcare providers and 300 patients. Qualitative interviews were conducted with 11 healthcare workers and 12 patients. At the evidence itself level, evidence meeting clinical needs and evidence lacking practical applicability, respectively, promoted and hindered clinical implementation of the best evidence. At the potential adopters’ level, healthcare professionals’ insufficient professional competence, low willingness to promote implementation, numerous concerns, and lack of autonomy and awareness regarding the importance of the task were significant barriers, but they maintained an overall positive attitude toward the application. At the practical environment level, patient-related perceived barriers predominantly hindered evidence implementation. Additionally, a supportive practice atmosphere, economic feasibility, and talent development opportunities served as key facilitators. However, existing nursing practice content and workflows directly impacted evidence adoption. Conclusions: The promotion and barriers to the clinical application of the best evidence for CIC in RH postoperative patients are multifaceted. Targeted intervention strategies must be developed to facilitate the effective translation of evidence into clinical practice. Full article

Rural adolescents face persistent health inequities driven by limited access to preventive health education, intergenerational engagement, and resources that support lifelong wellness. This study evaluated the effectiveness of Active Aging for L.I.F.E., a school-based intergenerational health literacy program, in improving adolescents’ attitudes toward aging and health. The four-session program, delivered through a train-the-trainer model involving older adults and undergraduate students, was implemented in three rural schools during the 2024–2025 academic year. A total of 86 junior high and high school students participated, with 77 completing pre- and post-program surveys assessing attitudes toward aging, health consciousness, and intergenerational engagement. Paired t-tests and multiple regression analyses examined overall program effects and differences by sex/gender and age group. Students demonstrated significant improvements in aging attitudes, perceived relevance of aging topics, enjoyment of intergenerational interaction, and awareness of health-promoting behaviors across the lifespan. Several baseline sex/gender and age-based gaps in health-related perceptions were reduced following participation, with stronger future-oriented attitude shifts observed among younger adolescents. These findings suggest that brief, scalable intergenerational interventions embedded in rural school settings can support early prevention, health literacy, and community capacity building, offering a promising strategy for advancing rural public health outcomes across the life course. Full article

Introduction: Marine recreational fishing (MRF) is a socially, economically, and ecologically important activity. However, the absence of systematic monitoring and research in Portugal has limited a comprehensive understanding of the sector and its broader implications. Addressing these gaps is essential to support evidence-based and adaptive recreational fisheries management. Objective: This work aimed to improve understanding of marine recreational fishing in Portugal by integrating social and biological perspectives across national, regional, and local scales. Methodology: A multidisciplinary approach was applied. At the national scale, online questionnaire data were combined with licencing information and regional effort estimates to quantify fishing effort, catches, release rates, catch composition, and direct trip expenditures. The same survey framework was also used to identify recreational fisher profiles based on motivations, behaviours, fishing practices, and attitudes toward management. At the local scale, shore angling surveys conducted before the implementation of the Natural Marine Park of the Algarve Reef were used to estimate fishing activity and establish a baseline for future monitoring. From a biological perspective, field-based catch-and-release experiments were conducted to assess post-release mortality and physiological disturbance, using indicators such as mortality, condition, capture and handling variables, and blood biomarkers of stress and recovery. Results: The national estimates documented substantial fishing effort, catches, and direct expenditure, confirming the relevance of MRF in Portugal at both ecological and socio-economic levels. Portuguese recreational fishers were also shown to be heterogeneous in their motivations, behaviours, and practices, reinforcing the need for management approaches that reflect this diversity. At the local scale, shore angling estimates from the Natural Marine Park of the Algarve Reef provided an important pre-protection baseline for the now established Marine Protected Area, enabling future comparisons and long-term assessment of management effects. Biological experiments showed that recreational fishing can generate measurable physiological disturbance in fish, with post-release condition influenced by capture and handling factors. Among the variables examined, hook location emerged as particularly important, with deep-hooked fish showing greater impairment and higher mortality risk. Conclusions: Together, these findings show that improving recreational fisheries management in Portugal requires integrating social patterns, fishery magnitude, and biological responses to capture and release. Long-term monitoring programmes, combined with management approaches adapted to different fisher profiles and fishing contexts, are essential to support more effective and sustainable recreational fisheries governance. Full article

Engineering design education is an effective instructional approach for enhancing students’ motivation, interest, and creativity while introducing them to the engineering design process (EDP). However, there is limited knowledge on how to integrate the EDP into robotics education, particularly AI-robotics, and how students experience AI-enabled robotics project-based learning grounded in an EDP. This pre-/posttest embedded mixed-methods study adds to the scarce body of literature on interdisciplinary education in engineering design, robotics, and AI. This project developed, implemented, and evaluated a project-based engineering design AI-robotics curriculum that introduced novice Computer Science (CS) high school students to robotics, machine learning, and AI. Students’ collaborative robotics projects were grounded in an EDP to introduce the students to engineering practices and promote engagement and interest through design-based, hands-on learning. An analysis of quantitative and qualitative data revealed an improvement in students’ CS attitudes, collaboration, and social interactions after participating in the curriculum. Recommendations for designing AI-robotics projects grounded in an EDP are discussed. Full article

This paper describes design, implementation and initial evaluation of Digital Twin Metaverse Classroom for higher education. Digital Twin Metaverse Classroom refers to highly realistic digital replicas or virtual replicas or prototypes of university classrooms or learning spaces. This paper focuses on creating high-fidelity digital replica of typical university lecture room. The main purpose of the Digital Twin Metaverse Classroom is to support teaching and learning in addition to traditional videoconferencing. The pilot involved thirty-two undergraduate students. A single-group pre-test/post-test quiz measured short-term learning, while the Technology Acceptance Model (TAM) measured acceptance through perceived usefulness, perceived ease of use, attitude toward use, and behavioral intention. A single session raised the mean quiz score from 6.41 to 9.19, a within-session gain that reached statistical significance, while all four TAM constructs scored highly. Because the sample was small and confined to one institution, with neither a control group nor a follow-up, these findings are best read as early evidence of feasibility, short-term improvement, and favorable acceptance rather than as proof of comparative effectiveness. Full article

Background/Objectives: Discharging patients after hospitalization for an acute exacerbation of chronic obstructive pulmonary disease (COPD) is a critical transition in care associated with a high risk of early readmission. This survey aimed to describe physician-reported discharge practices following COPD exacerbations, identify perceived gaps and organizational barriers, explore attitudes toward structured COPD discharge summaries, and use a SWOT analysis as an interpretative framework. Methods: In this cross-sectional observational survey, 100 physicians involved in COPD care were recruited from the official mailing list of the Respiratory Society of Serbia, which represents approximately 71% of the Society’s members. The survey assessed discharge procedures, multidisciplinary practices, patient education, comorbidity management, perceived causes of readmission, and barriers to structured discharge summaries. Data were analyzed descriptively and complemented with a structured SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis. Results: Most respondents worked in tertiary care settings and were involved in managing patients hospitalized for COPD exacerbations. Although 24% of physicians routinely used structured discharge summaries, 45% reported never using them. The most frequently perceived contributors to 30-day readmissions were active smoking (90%), poor treatment adherence (81%), comorbidities (77%), and incorrect inhaler technique (72%). Major barriers to implementing structured discharge summaries included the lack of standardized templates, time constraints, poor coordination across healthcare levels, and technical limitations. Willingness to implement structured discharge tools was high (mean score 8.86/10). SWOT analysis identified strong professional support for discharge standardization alongside organizational and system-level barriers to implementation. Conclusions: This exploratory survey identified important gaps between recommended and routine COPD discharge practices and highlighted organizational barriers to implementation. The findings may inform future evaluation and development of structured discharge tools in this healthcare setting. Full article

Violence against women and intimate partner violence in particular are recognized as significant social issues. This article explores the dynamic interplay between intimate partner violence, public opinion, and legislative changes in Bulgaria. The data we used were collected through in-depth interviews and focus groups with professionals working on issues of domestic violence and violence against women in Bulgaria. Using a specific case of violence as an example, the study argues that public pressure is a catalyst for changes in the legal framework for protection against domestic violence. However, the findings suggest a propensity for certain measures to be influenced by penal populism, often taking on the characteristics of symbolic policymaking—declaring political commitment, but showing vulnerabilities in their practical application. In this context, the perspective of policy implementation and unintended consequences reveals how gaps in institutional capacity, coordination, and enforcement produced outcomes that differed from those declared publicly. The article concludes that an integrated approach going beyond penal populism and symbolic policy demonstrations is necessary. To effectively combat domestic and intimate partner violence in Bulgaria, there is a need for a long-term strategy that considers the intricate relationships between public attitudes, policymaking, and the actual implementation of legislation. Full article

The sustainable development of forest ecotourism relies on the effective stimulation of tourists’ environmentally responsible behavior, and the intervention of participatory art and aesthetics provides a new driving force for this process. Taking Xiqiaoshan National Forest Park (Nanhai Land Art Festival) as a case study, we propose an extended stimulus–organism–response (S-O-R) theoretical framework to reveal the psychological perception and transmission mechanism of participatory art and aesthetic experience in empowering the sustainable development of ecotourism. We used a hybrid approach combining PLS-SEM and artificial neural networks (ANNs) to analyze survey data from 596 Chinese tourists. The study found that sensory impressions driven by art and aesthetics significantly and positively influence tourists’ natural connections, perceived value, and ecotourism attitudes. These three constructs function as significant parallel mediators between sensory impressions and environmentally responsible behavior, while chain mediation effects are statistically significant but of small magnitude. The new environmental paradigm (NEP), conceptualized as an individual trait boundary condition, exhibits a significant negative moderating effect on the relationship between sensory impressions and connectedness to nature. ANN sensitivity analysis further complements the findings by demonstrating the prominent nonlinear predictive role of ecotourism attitudes in behavioral transformation. This study extends the application boundaries of the S-O-R theory to art-integrated ecotourism research, clarifies the internalization process of tourist experiences from sensory perception to behavioral enactment, and provides empirical evidence for forest tourism managers to optimize experience design and implement differentiated guidance strategies. Full article

Background: This systematic review evaluates the evidence on sustainable practices in dentistry. It focuses on effective measures, innovative technologies, strategies for reducing the carbon footprint, life cycle assessments (LCA), attitudes toward “green” dentistry, and educational approaches. Methods: A systematic search was conducted in five databases (Cochrane Library, Embase, LILACS, MEDLINE via PubMed, and Scopus) without language restrictions in accordance with PRISMA. The review was registered in PROSPERO (CRD420251056821). Results: A total of 2395 records were identified; after removing 394 duplicates, 2001 remained for screening. After title and abstract screening, 154 full-text articles were evaluated, of which 51 studies were included. The included studies addressed life cycle assessments of dental materials, sustainable clinical practices, and educational measures. Environmentally friendly materials and procedures, such as reusable personal protective equipment and water-saving technologies, demonstrate significant potential for reducing environmental impact. Despite generally high acceptance among dentists and patients, implementation is often limited by financial and knowledge-related barriers. Conclusions: The implementation of sustainable materials and procedures is crucial for reducing environmental impact. Equally important are the integration of ecological content into education and appropriate financial and political frameworks to promote sustainable dentistry. Full article

AI use is associated with both cognitive relief and cognitive offloading, leading to uncertainty in how users make value judgments and decisions. This study focuses on in-class AI use and explores the perceptions of cognitive relief and cognitive offloading among university students, as well as the distinct mediating mechanisms through which these factors shape the attitudes of students. Based on questionnaire data from 287 respondents, structural equation modeling and bootstrap methods were employed to test the research hypotheses. The results show that cognitive relief exerts a complementary mediating effect between AI use and attitudes, whereas cognitive offloading functions as a competitive mediator. The two mechanisms produce opposing effects on students, with cognitive relief demonstrating a stronger overall mediating effect. These findings suggest that educators should guide students toward a more nuanced understanding of AI use to mitigate confusion and its potential negative psychological consequences. Moreover, educators and institutions should leverage AI to provide cognitive relief for higher-order learning activities, thereby enhancing the engagement, motivation, and deeper learning processes of students, while simultaneously implementing reflective and critical thinking practices to guard against the risks of cognitive offloading. This study is limited by its single-institution convenience sample and reliance on self-reported data; future research incorporating qualitative methods such as interviews and classroom observations is encouraged to further validate and extend these findings. Full article

Objectives: This study aims to assess the acceptance of vaccinations among pregnant women, particularly against influenza, pertussis, COVID-19, and RSV, and to identify factors influencing their willingness to get vaccinated. It also seeks to evaluate the impact of the COVID-19 pandemic on maternal attitudes and behaviors regarding vaccination. Methods: The analysis involved a review of existing literature and studies to evaluate the level of vaccine acceptance among pregnant women before and after the COVID-19 pandemic. Factors contributing to vaccine hesitancy, including misinformation, lack of knowledge, and the influence of healthcare professionals, were examined. Results: The findings indicated that, despite scientific evidence supporting the safety and efficacy of vaccines during pregnancy, public concerns remain about their impact on the developing fetus. The outbreak of the COVID-19 pandemic has increased awareness of the risk of infectious diseases, but at the same time, its impact on vaccination rates among pregnant women is ambiguous and geographically diverse. Misinformation and decreased access to healthcare during the pandemic negatively affected vaccine uptake. Trustworthy information provided by healthcare professionals emerged as a key factor in promoting vaccine acceptance. Conclusions: To improve vaccination rates among pregnant women, it is essential to provide clear, evidence-based information through healthcare professionals, particularly those directly caring for pregnant women. Educational campaigns should address concerns calmly and without judgment, emphasizing the safety and benefits of vaccinations. Enhanced access to healthcare and vaccinations, along with strategic information dissemination, can significantly improve vaccine acceptance during pregnancy. Lessons learned from past pandemics should be incorporated into the development of healthcare strategies aimed at implementing recommended vaccinations for pregnant women in the future. Full article

Background: Large language models and other generative artificial intelligence (AI) tools are increasingly being embedded in digital healthcare services, including mobile health applications, telerehabilitation, remote monitoring, and hybrid care pathways. In this review, digital healthcare refers to technology-mediated healthcare services in which digital platforms, mobile applications, wearables, remote communication, and AI-enabled interfaces support health assessment, self-management, rehabilitation, clinical decision support, or service delivery. When AI-generated exercise guidance moves from general education to individualized recommendations about dose, progression, contraindications, or rehabilitation, it may become directly actionable and safety-relevant. Objectives: This review aimed to clarify when AI-generated exercise guidance in digital healthcare may warrant safety-relevant governance attention and to outline implementation considerations for explainability, human oversight, and service-level governance. It addresses a gap in the literature: general AI-governance and exercise-prescription discussions rarely specify how point-of-use explanations, review thresholds, and escalation safeguards can be organized for directly actionable AI exercise guidance. Methods: We conducted a governance-oriented narrative review of peer-reviewed literature and representative regulatory or guidance documents. This review was not designed as a systematic review, scoping review, or exhaustive evidence map; transparent source mapping was used to support conceptual synthesis. Searches and source mapping focused on generative AI, large language models, explainable AI, clinical decision support, digital health, mobile health, exercise prescription, rehabilitation, trust, automation bias, and human oversight. Sources were included when they informed the safety, explainability, governance, or real-world implementation of patient-facing AI-generated exercise guidance. Extracted material was grouped by evidentiary role and synthesized through framework synthesis and governance mapping to distinguish literature-supported observations, author interpretation, and proposed implementation tools. Results: The included sources were first organized into five thematic groups: digital exercise delivery and exercise-prescription evidence; explainability, trust, and automation bias literature; professional responsibility, ethics, and patient disclosure literature; regulatory and policy documents; and digital literacy, patient/clinician attitudes, and equity literature. The synthesis then proceeded from safety relevance to explanation needs, human oversight and escalation needs, and selected regulatory and policy signals before translating these strands into conceptual and implementation-oriented outputs rather than empirically validated instruments. AI-generated exercise guidance was most safety-relevant in scenarios involving individualized dose, progression, contraindication-sensitive action, or rehabilitation strategy. Across the included sources, generic transparency alone was not sufficient to support reviewable use; relevant explanation elements included evidence sources, risk warnings, reasoning paths, and reasonable alternatives. Oversight considerations varied with embodied risk, clinical ambiguity, user vulnerability, and likelihood of direct enactment. Implementation considerations linked interface design, clinical review, escalation, auditability, and post-deployment monitoring. Conclusions: AI-generated exercise guidance in digital healthcare may warrant governance attention as a patient-safety and accountability issue when it influences actionable exercise decisions. The proposed framework offers a conceptual basis for designing more reviewable and accountable mobile and remote exercise-support services. Future work can validate these outputs in patient-facing services, clinician review workflows, usability studies, implementation pilots, and safety evaluations. Full article

Background/Objective: The increasing global population of older adults presents significant challenges for oral healthcare, particularly regarding the management of chronic conditions and prosthetic rehabilitation. Teledentistry, combined with intraoral scanning, offers a promising solution to enhance access, interdisciplinary collaboration, and clinical outcomes in geriatric populations. This study aimed to evaluate the utilisation of intraoral digital scanning within teledentistry for interdisciplinary oral assessment of older patients. Specifically, it investigated current clinical practices, collaboration among healthcare professionals, and perceptions regarding the effectiveness, challenges, and future potential of teledentistry in prosthodontic care. Methods: An analytical cross-sectional survey was conducted among 84 healthcare professionals, including dentists, prosthodontists, and postgraduate students, recruited via an international network. Participants completed a 40-item electronic questionnaire covering demographics, clinical practice, digital technology use, interdisciplinary collaboration, and attitudes toward research and innovation. Descriptive statistics summarised responses, and inferential analyses, including chi-square tests and Spearman correlations, examined associations between career stage, technology adoption, and interdisciplinary practices. Results: Early-career professionals demonstrated the highest adoption of intraoral scanning (76.3%), while mid-career adoption was lowest (28.6%). Sustained usage significantly increased after one year of adoption (93.8%). While 91.7% of respondents valued interdisciplinary care, active collaboration remained limited. Cost, technical barriers, and training gaps were identified as primary obstacles. Professionals perceived intraoral scanning as beneficial for prosthodontic outcomes and chronic inflammation management, though adoption was influenced by experience, systemic factors, and financial support. Conclusions: Teledentistry integrated with intraoral scanning has substantial potential to improve geriatric oral healthcare. Successful implementation depends on structured training, financial investment, and promotion of interdisciplinary collaboration. Future longitudinal and multicenter studies are warranted to evaluate clinical, economic, and patient-centred outcomes, supporting sustainable digital transformation in geriatric dental care. Full article