Search Results (895)

Background: The progression of Alzheimer’s Disease (AD) deeply affects not only the diagnosed person but also their close relatives, who are often called to take on the role of informal caregivers. This transition is frequently unplanned and emotionally complex, yet poorly understood in its deeper processual dimensions. This study aims to explore and theorize the transition experienced by a family member becoming the primary informal caregiver for a person with advanced AD. Methods: A qualitative study based on the Constructivist Grounded Theory according to Charmaz’s approach (2006) was conducted. In-depth interviews were carried out with 10 participants who had become informal caregivers for a loved one with advanced AD. Data were analyzed using initial coding, focused coding, the constant comparative method, and theoretical coding. Results: Ten caregivers (mean age 39 years, range 35–54; nine females) of patients with advanced AD participated in the study. The analysis revealed a complex, emotionally intense caregiving experience marked by sacrifice, feelings of powerlessness, identity loss, and the necessity of sharing caregiving responsibilities. A core category emerged: A Silent and Certain Willingness to Care, representing the caregivers’ deep, often unconscious commitment to prioritize the care of their loved ones above their own needs. Four interconnected phases characterized the caregiving process: (1) The Changing Daily Life—involving significant sacrifices in personal and social life; (2) Feeling Powerless—confronting the inevitable decline without means to alter the course; (3) Losing Oneself—experiencing physical and psychological exhaustion and a sense of identity loss; and (4) Sharing with Others—seeking external support to sustain caregiving. These findings highlight the evolving nature of becoming a caregiver and the enduring dedication that sustains this role despite the challenges. Conclusions: The progression of AD deeply transforms the lives of caregivers, who become co-sufferers and active participants in the disease’s management. The results underscore the urgency of designing integrative care strategies—including psychological, social, and potentially technological support—that can enhance both patient outcomes and caregiver resilience. Grounded in real-world experiences, this study contributes to the broader neurodegeneration discourse by emphasizing caregiving as a critical factor in long-term disease management and therapeutic success. Full article

As artificial intelligence (AI) technology becomes increasingly widespread in organizations, its impact on individual employees’ psychology and behavior has garnered growing attention. Existing research primarily focuses on AI’s effects on organizational performance and job design, with limited exploration of its mechanisms influencing individual employees, particularly in the critical area of risk-taking behavior, which is essential to organizational innovation. This research develops a moderated mediation model grounded in social cognitive theory (SCT) to explore how AI usage affects the willingness to take risks. A three-wave longitudinal study collected and statistically analyzed data from 442 participants. The findings reveal that (1) AI usage significantly enhances employees’ willingness to take risks; (2) self-efficacy serves as a partial mediator in the connection between AI usage and the willingness to take risks; and (3) learning goal orientation moderates both the relationship between AI usage and self-efficacy, as well as the mediating effect. This research enhances our understanding of AI’s impact on organizational behavior and provides valuable insights for human resource management in the AI era. Full article

Water is essential for ecological balance, environmental sustainability, and food security, particularly in arid regions where effective water management increasingly depends on farmer cooperation. The Samarkand region of Uzbekistan, known for its favorable climate and leading role in grape production, is facing rising drought conditions. This study explores the factors influencing grape farmers’ willingness to collaborate on water management in the districts of Ishtikhan, Payarik, and Kushrabot, which together produce 75–80% of the region’s grapes. A quantitative survey of 384 grape-producing households was conducted across 19 county citizens’ gatherings (38.7% of such gatherings), and structural equation modeling was employed to analyze a framework consisting of four dimensions: norms, environmental concerns, economic barriers, and the intention to adopt sustainable practices. The results indicate that norms and environmental concerns positively influence collaboration, suggesting a collective orientation toward sustainability. In contrast, economic barriers such as high costs and limited financial capacity significantly hinder cooperative behavior. Furthermore, a strong individual intention to adopt sustainable practices was associated with a greater likelihood of collaboration. These findings highlight the critical drivers and constraints shaping collective water use in agriculture and suggest that targeted policy measures and community-led efforts are vital for promoting sustainable water governance in drought-prone regions. Full article

The European Union Council’s zero vision aims to eliminate workplace fatalities, while Industry 4.0 presents new challenges for occupational safety. Despite HR professionals assessing managers’ and employees’ competencies, no system currently exists to evaluate the competencies of workers’ representatives in occupational safety and health (OSH). It is crucial to establish the necessary competencies for these representatives to avoid their selection based on personal bias, ambition, or coercion. The main objective of the study is to identify the competencies and their components required for workers’ representatives in the field of occupational safety and health by following the steps of the DACUM method with the assistance of OSH professionals. First, tasks were identified through semi-structured interviews conducted with eight occupational safety experts. In the second step, a focus group consisting of 34 OSH professionals (2 invited guests and 32 volunteers) determined the competencies and their components necessary to perform those tasks. Finally, the results were validated through an online questionnaire sent to the 32 volunteer participants of the focus group, from which 11 responses (34%) were received. The research categorized the competencies into the following three groups: core competencies (occupational safety and professional knowledge) and distinguishing competencies (personal attributes). Within occupational safety knowledge, 10 components were defined; for professional expertise, 7 components; and for personal attributes, 16 components. Based on the results, it was confirmed that all participants of the tripartite system have an important role in the training and development of workers’ representatives in the field of occupational safety and health. The results indicate that although OSH representation is not yet a priority in Hungary, there is a willingness to collaborate with competent, well-prepared representatives. The study emphasizes the importance of clearly defining and assessing the required competencies. Full article

Autonomous vehicles (AVs) have emerged as a promising sustainable urban mobility solution, expected to lead to enhanced road safety, smoother traffic flows, less traffic congestion, improved accessibility, better energy utilization and environmental performance, as well as more efficient passenger and freight transportation, in terms of time and cost, due to better fleet management and platooning. However, challenges also arise, mostly related to data privacy, security and cyber-security, high acquisition and infrastructure costs, accident liability, even possible increased traffic congestion and air pollution due to induced travel demand. This paper presents the results of a survey conducted among 654 residents who experienced an autonomous bus (AB) service in the city of Trikala, Greece, in order to assess their willingness to use (WTU) and willingness to pay (WTP) for ABs, through testing a range of factors based on a literature review. Results useful to policy-makers were extracted, such as that the intention to use ABs was mostly shaped by psychological factors (e.g., users’ perceptions of usefulness and safety, and trust in the service provider), while WTU seemed to be positively affected by previous experience in using ABs. In contrast, sociodemographic factors were found to have very little effect on the intention to use ABs, while apart from personal utility, users’ perceptions of how autonomous driving will improve the overall life standards in the study area also mattered. Full article

E-waste, a form of solid waste, contains many recyclable metals, but improper disposal can make it very harmful. Therefore, the recycling of e-waste is very important, and the willingness of residents to participate is crucial in e-waste recycling. Taking Jiangsu Province, China as an example, we used the theory of reasoned action (TRA) to construct a research model to investigate the factors influencing residents’ willingness to participate in e-waste recycling. The paper introduces impression management motivation and further reveals the application of the Hawthorne effect in e-waste recycling. The paper also introduces the awareness of benefits, which encompasses personal economic benefits, physical health benefits, and environmental benefits, with physical health benefits being ignored by most of the previous literature. In addition, knowledge and convenience are also introduced in this paper. A total of 400 valid responses were used to test the hypotheses of the structural equation model. It was found that all factors positively influenced residents’ willingness to engage in e-waste recycling. Attitude has a mediating role in the effects of convenience, knowledge, and awareness of benefits on willingness, and subjective norms have a mediating role in the effects of impression management motivation on willingness. The model explains 82.9% of the variance in residents’ willingness to recycle e-waste, surpassing the original TRA model’s explanatory power and confirming the strength of the extended framework. The study provides valuable policy implications for the government to promote e-waste recycling. Full article

The sustainable management of Municipal Solid Waste (MSW) relies heavily on community participation in separating it at the source and delivering it to collection systems. These practices are crucial for reducing pollution, protecting ecosystems, and maximizing resource recovery. However, in the Global South context, with conditions of socioeconomic vulnerability, community participation in the sustainable management of MSW remains limited, highlighting the need to generate context-specific interventions. MSW includes items such as household appliances, batteries, and electronic devices, which require specialized handling due to their size, hazardous components, or material complexity. This study implemented a Community-Based Social Marketing approach during the research and design phases of an intervention focused on promoting source separation and management of hard-to-manage MSW in five municipalities within the administrative region of Norte de Santander (Colombia), which borders Venezuela. Using a mixed-methods approach, we collected data from 1775 individuals (63.83% women; M _age = 33.48 years; SD = 17.25), employing social mapping, focus groups, semi-structured interviews, participant observation, and a survey questionnaire. The results show that the source separation and delivery of hard-to-manage MSW to collection systems are limited by a set of psychosocial, structural, and institutional barriers that interact with each other, affecting communities’ willingness and capacity for action. Furthermore, a prediction model of willingness to engage in separation and delivery behaviors showed a good fit (R2 = 0.83). The strongest predictors were awareness of the negative consequences of non-participation and perceived environmental benefits, with subjective norms contributing to a lesser extent. Based on these results, we designed a context-specific intervention focused on reducing these barriers and promoting community engagement in the sustainable management of hard-to-manage MSW. Full article

Background: Despite their high prevalence and potential for significant morbidity, hemorrhoidal symptoms remain underreported and undertreated. Misconceptions and stigma may delay care-seeking behaviors and negatively influence patient outcomes. Methods: We conducted a cross-sectional, questionnaire-based study in Romania to assess public awareness, attitudes, and barriers related to hemorrhoidal disease. The survey included 185 participants and evaluated variables such as symptom severity, understanding of the condition, perceived stigma, and willingness to consult a physician. Results: Only 30.8% of participants had sought medical advice for hemorrhoidal symptoms. Younger age (p < 0.001), male sex (p = 0.013), and lower levels of perceived severity were significantly associated with reluctance to seek medical care. The most frequently reported barriers were embarrassment and fear of invasive diagnostic procedures. Colonoscopy and digital rectal examination were identified as major deterrents by 39.5% and 38.9% of respondents, respectively. Educational level influenced both the perceived understanding of the disease (p = 0.001) and comfort in discussing anal symptoms (p = 0.002). Gender preference for physicians was significantly associated with respondent sex (p = 0.007) but not with education or age. Conclusions: Hemorrhoidal disease remains a stigmatized and underestimated condition. Public health efforts should prioritize educational interventions, destigmatization campaigns, and improved physician–patient communication to facilitate earlier diagnosis and better disease management. Full article

In the past decade, agricultural biogas plants have become one of the key tools driving the energy transition in rural areas. Nevertheless, their development in Poland still lags behind that in Western European countries, suggesting the existence of barriers that go beyond technological or regulatory issues. This study aims to examine how Polish farmers perceive the risks and expected benefits associated with investing in biogas plants and which of these perceptions influence their willingness to invest. The research was conducted in the second quarter of 2025 among farmers planning to build micro biogas plants as well as owners of existing biogas facilities. Geographic Information System (GIS) tools were also used in selecting respondents and identifying potential investment sites, helping to pinpoint areas with favorable spatial and environmental conditions. The findings show that both current and prospective biogas plant operators view complex legal requirements, social risk, and financial uncertainty as the main obstacles. However, both groups are primarily motivated by the desire for on-farm energy self-sufficiency and the environmental benefits of improved agricultural waste management. Owners of operational installations—particularly small and medium-sized ones—tend to rate all categories of risk significantly lower than prospective investors, suggesting that practical experience and knowledge-sharing can effectively alleviate perceived risks related to renewable energy investments. Full article

Background: Endoscopic therapies for Crohn’s disease (CD) strictures, including endoscopic balloon dilation (EBD) and endoscopic stricturotomy (ESt), are less invasive interventions compared to surgery. ESt is advantageous for strictures that are longer, more fibrotic, or adjacent to anatomic structures requiring precision, and it has shown a high rate of surgery-free survival. Methods: We designed a microsimulation state-transition model comparing ESt to surgical resection for CD strictures. We calculated quality-adjusted life years (QALYs) over a 10-year time horizon; secondary outcomes included costs (in 2022 USD) and incremental cost-effectiveness ratios (ICERs). We used a societal perspective to compare our strategies at a willingness-to-pay (WTP) threshold of 100,000 USD/QALY. Sensitivity analyses, both deterministic and probabilistic, were performed. Results: The surgery strategy cost more than 2.5 times the ESt strategy, but resulted in nine more QALYs per 100 persons. The ICER for the surgery strategy was 308,787 USD/QALY; thus, the ESt strategy was determined more cost-effective. One-way sensitivity analyses showed that quality of life after ESt as compared to that after surgery, the likelihood of repeat intervention, and surgical mortality and cost were the most influential parameters shifting cost-effectiveness. Probabilistic sensitivity analyses favored ESt in most (65.5%) iterations. Conclusions: Our study finds endoscopic stricturotomy to be a cost-effective strategy to manage primary or anastomotic Crohn’s disease strictures. Post-intervention quality of life and probabilities of requiring repeated interventions exert most influence on cost-effectiveness. The decision between ESt and surgery should be made considering patient and stricture characteristics, preferences, and cost-effectiveness. Full article

Background: Tobacco use is disproportionately high in rural areas, contributing to elevated cancer mortality, yet it often goes untreated due to limited access to care, high poverty and uninsured rates, and co-occurring substance use disorders (SUDs). This study explored the utility of using rapid qualitative analysis (RQA) to guide the adaptation of a tobacco-free workplace program (TFWP) in Texas healthcare centers serving adults with SUDs in medically underserved areas. Methods: From September–December 2023 and May–July 2024, we conducted 11 pre-implementation, virtual semi-structured group interviews focused on adapting the TFWP to local contexts (N = 69); 7 with providers (n = 34) and managers (n = 12) and 4 with patients (n = 23) in 6 healthcare centers. Two qualified analysts independently summarized transcripts, using RQA templates of key domains drawn from interview guides to summarize and organize data in matrices, enabling systematic comparison. Results: The main themes identified were minimal organizational tobacco cessation support and practices, and attitudinal barriers, as follows: (1) the need for program materials tailored to local populations; (2) limited tobacco cessation practices and partial policies—staff requested guidance on enhancing tobacco screenings and cessation delivery, and integrating new interventions; (3) contradictory views on treating tobacco use that can inhibit implementation (e.g., wanting to quit yet anxious that quitting would cause SUD relapse); and (4) inadequate environmental supports—staff requested treating tobacco-use training, patients group cessation counseling; both requested nicotine replacement therapy. Conclusions: RQA identified key areas requiring capacity development through participants’ willingness to adopt the following adaptations: program content (e.g., trainings and tailored educational materials), delivery methods/systems (e.g., adopting additional tobacco care interventions) and implementation strategies (e.g., integrating tobacco cessation practices into routine care) critical to optimizing TFWP fit and implementation. The study findings can inform timely formative evaluation processes to design and tailor similar intervention efforts by addressing site-specific needs and implementation barriers to enhance program uptake. Full article

Estimating the economic value of recreation and ecotourism is essential for sustainable ecosystem management and informed environmental policymaking. However, values derived from individual studies often vary because of subjective preferences and contextual variability, making it challenging to obtain generalizable estimates. To address this issue, this study employed a meta-regression analysis synthesizing 179 willingness-to-pay (WTP) observations obtained from 48 individual valuation studies conducted across various recreational and ecotourism sites in the Republic of Korea. Focusing specifically on national parks, which are prominent providers of cultural ecosystem services, we examined how site characteristics, study design factors, and valuation methodologies influenced estimated WTP values. Outliers were systematically identified and treated using statistical methods, with the random-effects model utilizing studentized residuals yielding the most robust results. Our findings revealed that national parks and studies employing the travel cost method (TCM) were associated with significantly higher WTP values. By applying the developed meta-regression model, we estimated that the total value of recreational and ecotourism services provided by national parks in the Republic of Korea was approximately USD 865.0 million in 2020. These results highlight the effectiveness of meta-regression analysis in synthesizing heterogeneous valuation studies, facilitating more accurate benefit transfers, and offering empirical insights to guide ecosystem service policy and management decisions. Full article

Faxonius limosus is an invasive alien crayfish species that has a negative effect on aquatic biodiversity. Using its meat as food could help reduce its ecological impact while providing a protein source. In order to do that, the initial step was to determine safety and nutritional parameters of crayfish meat. Samples from two localities were analyzed for energy value, moisture, ash, protein, fat, carbohydrates, fatty acid and amino acid composition, and macro- and micro-mineral content. Moreover, an online survey was conducted in order to evaluate the public’s current knowledge about invasive alien species and willingness to consume crayfish meat as a food product. Heavy metal concentrations (Hg, Pb, Cd) were below European Commission limits, confirming safety. The meat had a high protein content (16.68%), low fat (0.22%), and a favorable fatty acid profile with notable levels of omega-3 polyunsaturated fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Predominant macro-minerals were K, Na, Ca, Mg, and P, while Zn, Cu, Fe, and Mn were the most abundant micro-minerals. Even though most participants (79.7%) were not informed about Faxonius limosus, the majority expressed willingness to participate in the assessment of new products made from invasive crayfish. These findings suggest that F. limosus meat is a nutritionally valuable and safe alternative protein source, with potential for sustainable food production and ecological management. Full article

Background and objectives: Duloxetine is widely used for the treatment of major depressive disorder (MDD), generalized anxiety disorder (GAD), and various types of neuropathic pain. While its efficacy is well documented in clinical trials, less is known about how it is perceived and utilized in routine psychiatric practice. To address this knowledge gap, we conducted a cross-sectional observational study involving 80 psychiatrists from Spain to assess real-world clinical attitudes toward duloxetine. Methods: Participants completed a 20-item multiple-choice questionnaire that examined familiarity, perceived efficacy in multiple conditions (MDD, GAD, neuropathic pain, somatization, and quality of life), and perspectives on tolerability, safety, adherence, and overall satisfaction. Results: Survey results indicated that a large majority of psychiatrists frequently prescribe duloxetine, particularly for patients with MDD and comorbid chronic pain. Notably, 94% rated it as either “more effective” or “much more effective” for diabetic peripheral neuropathic pain. Psychiatrists reported a high perceived efficacy of duloxetine: 94% rated it as “more effective” or “much more effective” for diabetic peripheral neuropathy, and 93% gave similarly positive ratings for general neuropathic pain. For somatization, 70% found it “effective” or “very effective”, and 83% observed improvements in quality of life for many of their patients. Psychiatrists generally reported favorable perceptions of duloxetine’s tolerability profile: 97.5% rated it as the antidepressant associated with the least weight gain, and 82.5% perceived fewer sexual side effects compared to other options. Sedation and gastrointestinal side effects were generally considered mild or less severe. In terms of treatment adherence, 69% rated it as “better” or “much better” than other antidepressants, and 80% found its combination with other antidepressants to be “favorable” or “very favorable”. Overall satisfaction was high, with 99% of psychiatrists reporting being either “satisfied” or “very satisfied” with its use. The side effect profile was generally viewed as manageable, with low perceived rates of weight gain, sedation, and sexual dysfunction. Furthermore, 96% of respondents expressed a willingness to recommend duloxetine to their colleagues. Conclusions: Psychiatrists reported highly favorable attitudes toward duloxetine, viewing it as a flexible treatment option in routine care. However, these findings reflect clinicians’ subjective perceptions rather than objective clinical outcomes and should be interpreted accordingly. Full article

Background: Understanding the determinants of children’s outdoor play is an important element for child development and broader public health outcomes. There is growing evidence that children’s opportunities for play, particularly outdoor risky play, are diminishing. Parents are concerned with keeping their child safe while affording them independence to play. This study explored parents’ attitudes to risky play and practices around children’s independent mobility in Ireland with the aim of informing public health strategies promoting healthy childhood environments. Methods: An online survey comprising validated scales and standardised questions was completed by a nationally represented sample of 376 parents of children up to 16 years. Data was analysed via descriptive statistics, chi-square tests, and regression analysis. Results: A total of 376 participants accessed the survey, of which 349 completed it. A total of 84% of participants were female. A total of 74% agreed that children need regular exposure to actual risk to develop risk management skills, and 71% trusted their children to play safely. Chi-square tests reveal significant associations between outdoor play in the rain and school travel (p < 0.01), and appropriate age to begin activities at home and in educational settings (p < 0.05). A moderate association was found between the method of school travel and children’s permission to play in the rain (Cramer’s V = 0.51). Respondents considered supervision to be a necessity to ensure their children’s safety. Overall, the results indicate that parents were risk-averse in three of the six categories of risky play, namely, play near dangerous elements, play with adult tools, and out-of-sight play. Conclusions: This study presents a descriptive analysis of findings from the Ireland State of Play Survey. Findings indicate that although parents recognise the benefits of risky play, there is some contradiction between parental attitudes and actual practices, with a lack of willingness or confidence in permitting their children to participate in all such activities. Full article