Search Results (783)

Understanding the role of trust in shaping pro-ecological behaviour is essential for advancing effective environmental communication, particularly in societies characterized by low institutional credibility. This study examines how different forms of trust—scientific, institutional, mediatic, and interpersonal—predict pro-ecological behaviour in Bulgaria, a context marked by historically low levels of social and institutional trust. Drawing on a nationally representative survey of 1008 adults, participants rated their trust in six sources of environmental information (experts, public servants, politicians, media, social networks, and friends or relatives) and reported their engagement in various ecological practices. Multiple regression analysis revealed that trust in experts was the strongest positive predictor of pro-ecological behaviour, followed by trust in friends and relatives. Trust in political institutions, media, and online social networks showed no significant associations. These findings suggest that in low-trust societies, interpersonal trust and trust in experts serve as primary drivers of ecological engagement, while institutional trust alone is insufficient to mobilize collective environmental action. The study underscores the importance of fostering both scientific credibility and community-based communication to enhance public participation in sustainability initiatives. Full article

Background and Objectives: Despite critically low levels of chronic kidney disease (CKD) awareness worldwide, there is no psychometrically validated instrument to comprehensively assess CKD awareness across socioecological levels. This study aimed to develop, psychometrically evaluate and validate a multidimensional awareness scale grounded in socioecological theory for patients with stage 3–4 CKD. Materials and Methods: This methodological study enrolled 908 stage 3–4 CKD patients. Scale development proceeded through systematic stages: comprehensive literature review, qualitative interviews (n = 15), expert panel evaluation (n = 25), and pilot testing. The initial 72-item pool was refined to 41 items (Content Validity Index = 0.912). The sample was randomly split for exploratory factor analysis (EFA; n = 454) and confirmatory factor analysis (CFA; n = 454). Psychometric evaluation encompassed internal consistency (Cronbach’s α, McDonald’s ω), test–retest reliability (n = 30; 4-week interval), convergent validity (average variance extracted [AVE], composite reliability [CR]), discriminant validity (Fornell–Larcker criterion), and criterion validity (correlation with Turkish Health Literacy Scale-32 [TSOY-32]). Results: EFA revealed a seven-factor structure with an acceptable explained variance of 43.8%. Following iterative item elimination based on communalities (h² < 0.20) and factor loadings (λ < 0.30), CFA confirmed the final 34-item model with good fit (CFI = 0.972; RMSEA = 0.070 [90% CI: 0.067–0.074]). The factor structure captured awareness across core socioecological levels (Individual, Interpersonal/Institutional, Community, and Systemic), complemented by Treatment Adherence and Social Impact dimensions. Internal consistency coefficients were α = 0.884 and ω = 0.889 for the total scale. Test–retest reliability yielded an ICC of 0.954 (95% CI: 0.907–0.978). Convergent and discriminant validity were confirmed via composite reliability (CR: 0.740–0.953) and the Fornell–Larcker criterion. Criterion validity analysis revealed a significant correlation with TSOY-32 (r = 0.810, p < 0.001). Conclusions: The CKD Awareness Scale (CKD-AS-34) represents a novel, psychometrically validated, multidimensional awareness instrument for CKD. This scale enables clinicians to identify awareness deficits spanning individual to systemic levels, facilitating personalised patient education and targeted public health interventions. Full article

Background: In multicultural healthcare systems such as the Italian one, migrant children may experience dental care as particularly stressful because linguistic and cultural barriers can limit communication, emotional expression, and understanding of the clinical setting. Aim: Understanding the emotional experience of migrant children during dental visits is essential for improving clinical management in pediatric dentistry and orthodontics within multicultural contexts. Because linguistic barriers often limit verbal communication, this study aimed to explore children’s mental representations, emotional states, and perceptions of the dental environment through drawing and to evaluate the clinical implications for communication and therapeutic collaboration. Methods: This qualitative study was conducted in Italy between 2016 and 2025 and analyzed 50 drawings produced by 50 foreign-born migrant children aged 6–13 years, recruited through an educational cooperative in Piacenza. Most participants originated from developing countries and had limited proficiency in Italian, frequently showing a marked “experience gap” in drawing ability that interfered with normative developmental stages described by Lowenfeld. The analysis focused on spatial organization, line quality, color use, posture, interpersonal distance, and representation of the clinical environment, integrating graphic competence assessment with emotional interpretation. Results: Younger children commonly depicted rigid lines, essential settings, and oversized dental unit lamps, whereas older children increasingly represented threatening or disproportionate instruments, aggressive dentists, and omission of the patient figure. Around age 10, drawings became more detailed and colorful, although symbols of closure, such as locked doors, persisted. In adolescents, representations polarized between rich, coherent scenes and extremely essential drawings dominated by fear, rigidity, minimal environments, and symbols of constraint. The findings suggest that drawing may represent a valuable non-verbal clinical and communicative resource for exploring migrant children’s emotional experience of dental care and for identifying signs of anxiety and vulnerability that may not emerge through verbal interaction alone. Conclusions: These findings support the value of a culturally sensitive dental approach integrating drawing, visual aids, multilingual educational materials, and play-based strategies to reduce communication barriers and improve cooperation in migrant children receiving pediatric dental and orthodontic care. Full article

The COVID-19 pandemic transformed healthcare education, increasing the shift to digital tools and establishing a hybrid curriculum blending online learning with traditional clinical practice. This study aims to understand how this shift impacts the educational growth and skill building of nursing students. A qualitative approach was conducted to understand the experience of Hong Kong nursing students adapting to online learning during the pandemic and beyond. Fifty nursing students were interviewed, and Colaizzi’s phenomenological method revealed key themes in their learning narratives. The analysis revealed four distinct themes characterizing the students’ experiences: (i) Learning on their terms: the mandated shift in healthcare reflecting a lack of agency during the educational transition; (ii) Knowledge without touch: the perceived incompetence of the COVID-19 nursing cohort, highlighting anxieties regarding a lack of hands-on clinical proficiency; (iii) Words left unsaid: The weight of insecurity, indicating a decline in interpersonal skills due to isolation; and (iv) Beyond the perfect algorithm: the unrehearsed art of care, describing the difficulty in translating digital simulations to complex, human-centric patient care. Findings show that while digital progress ensured continuity in education, it also contributed to reduced clinical confidence, weaker communication skills, and shifts in how nursing students approached their learning. Consequently, the post-COVID environment demands that training programs evolve to address these specific deficits. Advancing the existing pandemic-era nursing literature, this study emphasizes the need for diverse, targeted teaching methods to mitigate these gaps. By intentionally bridging theoretical knowledge with hands-on clinical practice, educators can better support student wellbeing and help restore the confidence and competence required of future graduates. Full article

Background: This study examined age-related differences and interrelationships among psychological symptoms, personality traits, and emotional expression styles in a community sample of 151 participants aged 10–77 years, spanning four age groups: adolescents, young adults, middle-aged adults, and older adults. Methods: Psychological symptoms were assessed using the SCL-90, personality traits using the Big Five Inventory-2 (BFI-2), and emotional expression patterns were derived from facial expression recognition via a convolutional neural network (CNN) model. Kruskal–Wallis H tests were used to examine age-related differences. K-means cluster analysis was applied to identify emotional expression patterns, and logistic regression was used to construct a mental health risk screening model. Results: The young adult group (19–35 years) achieved the highest scores on the depression (M = 1.73) and anxiety (M = 1.61) dimensions, indicating a higher level of psychological distress during this life stage. Personality traits showed a significant developmental trajectory: neuroticism decreased with age (H(3) = 17.09, p < 0.001, η² = 0.11), declining from 2.69 in the young adult group to 2.17 in the older adult group; conscientiousness increased with age (H(3) = 37.39, p < 0.001, η² = 0.24), representing the most substantial age-related effect. K-means clustering identified three distinct emotional expression patterns: Cluster 1 was characterised by happiness, Cluster 2 by anger, disgust, and fear, and Cluster 3 by neutrality, sadness, and surprise. Cluster 2 exhibited the highest scores on neuroticism, anxiety, depression, and mood swings, and scored significantly higher than the other two clusters on interpersonal sensitivity, depression, anxiety, and hostility (p < 0.05). Mental health risk screening indicated that 26.5% of participants were classified as high-risk. Logistic regression analysis (AUC = 0.742) showed that neuroticism was the strongest predictor of elevated mental health risk (OR = 4.58), while extraversion (OR = 0.41) and conscientiousness (OR = 0.57) were significant protective factors. Conclusions: These findings provide exploratory evidence regarding age-related patterns of psychological symptoms and personality traits in a convenience sample and offer preliminary support for personality-based mental health risk screening. Notably, the SCL-90 was employed as a screening tool rather than for clinical diagnosis. Given the unequal age group sizes, particularly the small young adult subgroup, generalisability across the lifespan should not be assumed. Full article

This study seeks to inform emergency preparedness efforts by summarizing the pandemic’s impacts on access to opioid use disorder (OUD) recovery support as reported by women in recovery. In-depth interviews were completed with adult women in recovery from OUD. We used a primarily deductive approach to coding and analysis. Two coders analyzed transcripts; discrepancies were resolved through discussion. Seventeen women completed interviews from June to October 2020. Pandemic impacts primarily focused on engagement in care and retention at community and interpersonal levels. Community-level barriers to engagement included facilities’ halting intake of patients and fear of COVID-19 infection in treatment settings. Interpersonal barriers to engagement included loss of childcare support and the sudden transition to virtual services. Community-level retention barriers included perception of facility staff’s lack of adherence to infection prevention protocols and strict enforcement of infection prevention protocols on residents within facilities. Interpersonal barriers to retention included reduced availability of mutual aid meetings. Participants also highlighted how the pandemic worsened the addiction crisis and increased women’s caretaking burden. Leaders and administrators must be prepared to simultaneously balance responses for two public health crises: a novel infectious disease and addiction. Lessons learned from the pandemic can mitigate barriers to care and recovery when future emergencies arise. Full article

Background: Adolescence is a critical developmental period marked by reorganization of attachment relationships, heightened emotional reactivity, and ongoing maturation of reflective and regulatory capacities. Within this context, mentalization and emotion regulation have emerged as key concurrent associations linking attachment security to both vulnerability and resilience. This scoping review examined how mentalization and emotion regulation are conceptualized and operationalized in adolescent attachment research and synthesized empirical evidence on their interaction across clinical and non-clinical samples. Methods: Following PRISMA-ScR guidelines, four electronic databases were searched for peer-reviewed studies published between 2015 and 2025. Twelve studies met the inclusion criteria, encompassing community, high-risk, and clinical samples and employing cross-sectional, psychometric, and prospective designs. Results: Across studies, attachment security was consistently associated with more adaptive emotion regulation and higher mentalization capacities, whereas emotion regulation difficulties were linked to internalizing and externalizing psychopathology. Mentalization was frequently reported as a mediator or correlate in the association between attachment security and emotional outcomes, while epistemic trust emerged as a promising interpersonal concurrent association with adaptive functioning. Conclusions: Findings highlight differentiated patterns of vulnerability and resilience and underscore the need for theoretically integrated, multimethod assessment frameworks to guide future research and prevention efforts in adolescence. Full article

Introduction: Religious practices can shape lifestyles, influence health choices, and help individuals cope with illness and suffering. Understanding which aspects of religiosity support health-promoting attitudes is particularly important. This study explores how belonging to a religious community affects health and well-being among religious sisters. Materials and Methods: An anonymous survey was conducted among 463 women from international, apostolic Catholic congregations in Poland and 33 other countries. The questionnaire included questions on lifestyle, physical health (including diet, physical activity, sleep, chronic conditions, and medication use), and perceptions of how community life influences health and encourages health-conscious behaviors. Results: Overall, 57% of participants reported following a healthy lifestyle, most commonly sisters aged 65 and older (73%). Non-Polish sisters and those living outside Poland were more likely to report healthy habits. Among sisters who saw their community as beneficial for health, 69% led a healthy lifestyle. Retreats, a sense of belonging, communal prayers, and vacations were consistently rated as having the most positive impact on well-being, particularly among older sisters and missionaries. Conclusions: Life in a religious community appears to support health both directly, through structured daily routines and shared responsibilities, and indirectly, by providing social support and fostering a sense of purpose. Spiritual practices, rest, and close interpersonal relationships emerge as the most influential factors for well-being, while formal obligations such as wearing religious attire or attending formation meetings were rated as less impactful. These findings highlight the important role of communal life in promoting both physical and spiritual health among religious sisters. Full article

Workplace relationship research has expanded rapidly across multiple disciplines, yet qualitative approaches to studying workplace relationships often remain constrained by single-participant designs, organization-centered analyses, and lingering post-positivist assumptions about rigor. Responding to these limitations, this article offers a methodological and conceptual primer for qualitative workplace relationship research grounded in interpersonal, organizational, constitutive, and reflexive traditions. Drawing on recent scholarship, the article first reviews contemporary conceptualizations of workplace relationships and highlights trends in qualitative research over the past decade. It then advances three generative directions for future inquiry: dyadic and multiadic research designs that capture relational co-construction; sociomaterial analyses that attend to objects, documents, bodies, and spaces as relationally consequential; and topic-centered approaches that theorize emergent workplace phenomena from participant-centered perspectives rather than theory-down deduction. The article further addresses questions of quality and rigor by engaging Tracy’s “big-tent” criteria and introducing the Qualitative Relationship Reporting Framework (QRRF-4), a relationship-centered reporting aid designed to support transparency and ethical accountability without reducing qualitative rigor to procedural compliance. Taken together, this article serves as both a practical resource and a theoretical invitation, supporting rigorous, reflexive qualitative research that illuminates the communicatively constituted, materially situated, and meaning-centered dynamics of contemporary workplace life. Full article

Background: Informal caregivers experience elevated psychological distress but face substantial challenges in accessing mental health support. Prior research has focused primarily on individual or interpersonal determinants, with less attention to how organizational, community, and policy contexts shape access and contribute to inequities in service availability. Methods: Fifty-one stakeholders, including 17 informal caregivers, 23 community health workers (CHWs), and 11 mental health professionals, completed a demographic survey and 60–90-min semi-structured interviews in English or Spanish. Data were analyzed using thematic analysis, combining deductive coding guided by the Socioecological Model with inductive identification of emergent themes. Results: Participants identified both barriers and supports influencing access to caregiver mental health support across socioecological levels. Individual-level barriers included limited mental health literacy, stigma, competing responsibilities, and language or technology challenges. Interpersonal barriers reflected family minimization of distress and limited encouragement for help-seeking. Organizational barriers involved program instability, restrictive eligibility criteria, long wait times, limited cultural responsiveness, and workplace constraints, while community-level influences included stigma and scarce affordable services. Policy-level barriers reflected immigration-related exclusions and the absence of caregiver-specific mental health coverage. Identified supports, such as CHW navigation and culturally responsive services, were often constrained by structural and organizational limitations. Conclusions: Caregivers face intersecting, multilevel barriers that constrain access to mental health support, while available supports are frequently insufficient to overcome structural constraints. Findings highlight the need for coordinated public health and systems-level strategies that address organizational and policy conditions shaping equitable access to caregiver mental health care. Full article

Background: Cyberbullying has emerged as a major public health concern with profound psychological repercussions on the adolescent population. The shift toward virtual communication has fundamentally altered interpersonal dynamics, removing the spatio-temporal barriers of aggression and creating new challenges for mental health. Methods: A systematic review was conducted following PRISMA 2020 guidelines, including a comprehensive update executed in February 2026. Searches were performed across PubMed, EBSCO, Web of Science, and Scopus. The review included observational and experimental studies involving adolescents (aged 10–19 years) reporting clinical mental health outcomes. Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. Results: Forty-two high-quality articles were selected. Key findings include the following: Prevalence: A median cyber-victimization prevalence of 19.1% was identified, although significant methodological heterogeneity exists with ranges between 2.1% and 88.0%. Clinical Impact: Victims exhibited significantly elevated rates of depression (90%) and anxiety (87%) compared to uninvolved peers. Suicidality: Victimization is a critical risk factor, with suicide attempts reported in 19.0% of victims, compared to 3.0% in aggressors. Vulnerable Groups: Adolescents with autism spectrum disorder (ASD) demonstrated extreme vulnerability, with victimization rates between 64.1% and 68.9%. Additionally, females and LGBTQ+ youth showed a higher risk of symptom internalization and post-traumatic stress. The Role of the Bystander: Observers experienced fear, moral frustration, and helplessness, acting as either passive reinforcers or active upstanders depending on the school climate. Conclusions and Implications: Effective prevention requires a socio-ecological approach that transcends the classroom, integrating families, healthcare centers, and technological platforms. A transition toward modernized cyber-education is recommended, utilizing interactive tools and “serious games” to foster empathy. Full article

Sextortion has rapidly expanded into a global cyber-enabled crime that leverages anonymous digital communication and decentralized payment systems. This study examines the financial infrastructures underlying contemporary sextortion by conducting a two-phase analysis of 87 confirmed cases involving cryptocurrency payments. Using blockchain forensic tools and open-source intelligence, the research traces fund movements across perpetrator-controlled wallets, identifies laundering techniques such as mixers, peel-chain transfers, and exchange-based cash-outs, and links these behaviors to narrative patterns within victim reports. The results reveal a dual-tier ecosystem in which mass-produced, multilingual extortion scripts coexist with divergent laundering typologies that differentiate lower-value, high-volume scams from more organized and higher-yield operations. By integrating qualitative and quantitative evidence, this study provides a forensic framework for detecting illicit cryptocurrency activity, improving threat classification, and strengthening investigative and regulatory responses to sextortion and related crypto-enabled interpersonal crimes. Full article

Introduction: In recent decades, demographic aging has led to an inversion of the population pyramid, with a marked increase in the proportion of older adults. This shift has been accompanied by a higher prevalence of chronic and life-limiting diseases, while there have also been significant technical and scientific advances. However, these developments have not been matched by a proportional expansion of healthcare human resources, including in palliative care (PC). Consequently, healthcare systems face increasing pressure, particularly in the provision of end-of-life care. Artificial intelligence (AI) has emerged as a promising tool to support and improve healthcare delivery. Objective: This study aims to review the literature on the impact of AI on palliative care, with particular emphasis on its clinical applications and ethical implications in end-of-life care. Methods: A narrative review was conducted using a structured search of PUBMED, CINAHL and Web of Science databases, covering publications from the last ten years (2015–2025). Search terms included combinations of “artificial intelligence”, “machine learning”, “palliative care”, “end-of-life care”, and “ethics”. Articles were included if they addressed clinical applications, implementation challenges or ethical aspects of AI in PC. Reference lists of selected articles were screened to identify additional relevant studies. The findings were analyzed and synthesized thematically into key domains of application and ethical concern. Results: The literature suggests that AI is currently a promising tool in PC, particularly in prognostication, symptom assessment, clinical decision support, and communication. These applications may represent a paradigm shift compared to conventional approaches. However, it is important not to forget that patients in PC need much more than algorithmic decision trees. Thus, current evidence is largely exploratory, with limited real-world validation. Empathetic emotional support, physical comfort and compassion are things that artificial intelligence cannot provide. AI does not replace humans in interpersonal relationships and dignity; it only complements them. Conclusions: AI-based technologies hold significant potential to address contemporary challenges in PC, including inequitable access, workforce strain, and the need for more efficient service delivery. Nevertheless, their implementation raises substantial ethical concerns related to autonomy, transparency, data governance, and the preservation of human dignity. AI should therefore be understood as a complementary tool that supports—but does not replace—the human dimension of PC. Full article

Dating violence (DV) is an increasingly prevalent phenomenon among emerging adults (aged 18–25 years), and the relationship between awareness and behavior remains poorly understood. This study explores emerging adults’ attitudes and beliefs toward DV and summarizes recommendations for designing prevention programs. A qualitative study using three focus groups (n = 16 emerging adults aged 18–25; 56% female) was conducted. Data were collected via semi-structured interviews and analyzed using thematic analysis. Three main themes emerged: (1) gender roles, (2) healthy intimate relationships, and (3) dating violence. Participants demonstrated high awareness of DV types, severity, and prevalence. However, they also exhibited an attitude–behavior inconsistency, reflected in the normalization and excusing of violence, and difficulty recognizing violent situations in their own relationships. Myths of romantic love and cognitive dissonance between general knowledge and personal experience create barriers to recognizing abuse—particularly psychological abuse, which is often confused with concern. Participants suggested integrating prevention strategies into schools and communities, with interventions tailored to their interests and realities (e.g., mobile applications, games and social media awareness campaigns). This study reveals that awareness and knowledge alone are insufficient for prevention. Efforts should shift from a knowledge-focused to a behavior-change approach, promoting emotional regulation, interpersonal skills, and addressing social and gender norms. Relevant implications for practice and preventive intervention design are discussed. Full article

Background: Democratic participation depends on three foundational social mechanisms: communication, interpersonal relationships, and socialization. While these mechanisms are well-understood in physical civic settings, their operation in digital environments remains unclear. For the purposes of this review, “fragility” is defined as a structural property of participatory systems, referring primarily to the conditional and variable alignment of these three mechanisms—an alignment that physical environments tend to support by default but that digital environments reproduce only under specific conditions. Methods: This study conducted a targeted high-impact review of twenty-two highly cited Scopus publications (2004–2025) to assess whether communication, interpersonal relationships, and socialization continue to function as core, but not individually sufficient, conditions for democratic engagement online. The review synthesizes findings across three research questions examining each mechanism, using narrative thematic analysis to identify dominant patterns within citation-established scholarship. Results: Across the reviewed corpus, participation strengthens when communication is informationally rich and heterogeneous, when relationships foster trust and bridging social capital, and when socialization environments support civic learning and identity formation. Weak informational content, homogeneous networks, and reduced socialization produce thinner or unstable democratic outcomes. The findings reveal that the three mechanisms operate interdependently: their democratic effects depend on simultaneous alignment rather than individual presence. Conclusions: Digital environments can support meaningful participation only when platform architecture reinforces these core social mechanisms. Strengthening informational diversity, relational openness, and digital socialization is essential for robust platform-mediated democratic engagement. Synthesizing these findings, the study proposes a Conditional Model of Digital Democratic Participation, which argues that digital fragility arises not from the medium itself but when the qualitative conditions required to validate the core social mechanisms fail to align. The Conditional Model differs from existing frameworks by treating communication, relationships, and socialization as interdependent mechanisms whose democratic effects are conditional on their simultaneous presence. Digital participation is not weak—it is conditional. Full article