Search Results (5,835)

Background: Endometriosis is a chronic condition associated with substantial healthcare costs, diagnostic delays and long-term impairment in quality of life. Despite the recognized economic burden, patient-reported financial distress remains insufficiently studied. The aim of this study was to adapt and validate the Polish version of the Comprehensive Score for Financial Toxicity (COST-FACIT) for use in women with endometriosis, as well as to examine demographic and clinical factors associated with financial toxicity. Methods: A cross-sectional study was conducted among Polish women with endometriosis using an online survey. The COST-FACIT was adapted following standard forward–backward translation procedures, with FACIT approval. Psychometric evaluation included internal consistency, construct validity, convergent validity with the Financial Well-Being Scale, and test–retest reliability. Exploratory and confirmatory factor analyses were performed, and multivariable models were used to identify factors associated with financial toxicity. Results: The adapted scale demonstrated good psychometric properties, with excellent internal consistency (Cronbach’s α = 0.92; McDonald’s ω = 0.92) and strong test–retest reliability (r = 0.87). Exploratory factor analysis supported a two-factor structure of the instrument. COST-FACIT scores were strongly correlated with financial well-being (r = 0.78). Higher education, stable employment and higher income were associated with better financial well-being, whereas longer symptom duration, greater distance to care and higher healthcare expenditures were associated with worse scores. Conclusions: The Polish COST-FACIT demonstrated good psychometric properties and may serve as a useful instrument for assessing financial toxicity in women with endometriosis. The results highlight the financial burden of the disease and support the use of patient-reported measures to identify individuals at risk of financial distress and reduced quality of life. This tool may facilitate clinical research and improve patient-centered care. Full article

In the context of revitalizing rural development, farmer entrepreneurship has emerged as a significant driver of rural economic growth. However, existing research has not sufficiently examined the specific mechanisms or heterogeneous effects through which digital skills influence farm household entrepreneurial behavior. This gap is the focus of the present study. Utilizing micro-level survey data collected from 936 farm households across Shandong, Shaanxi, and Henan provinces in 2021, we construct a digital skills index using factor analysis. We then employ a Probit model and an Interaction term model to examine the impact of digital skills on entrepreneurial behavior among Chinese rural households and its underlying mechanisms. Additionally, we explore heterogeneity across different household types. The results show that digital skills are positively associated with entrepreneurial decision-making. Further analysis provides suggestive evidence that this relationship may operate through three channels: shaping risk preferences, expanding relational networks, and improving access to credit. Heterogeneity tests reveal that the promoting effect of digital skills is stronger among disadvantaged households, households with a head younger than 45, and those engaged in opportunity-driven or online entrepreneurship. Theoretically, this study contributes by empirically validating a multi-pathway mechanism framework and identifying relevant boundary conditions. Practically, it offers targeted insights for policymakers to design skill-based interventions and foster inclusive entrepreneurial ecosystems in rural areas. Full article

This study addresses second-home ownership not merely as a form of tourism accommodation or real estate investment, but as a home-building process intersecting with local life, belonging, daily practices, and sustainable destination governance. While the economic, environmental, and community impacts of second-homes have been extensively discussed in the literature, how individuals perceive their primary and secondary homes differently in terms of the bodily, material, vibrant, imaginary, and emotional dimensions of home has been examined in a limited number of studies. This research analyzes paired data obtained through a two-stage online questionnaire from 223 British participants who own a secondary home in the Mugla–Ortaca region and a primary home in the United Kingdom. The 18-item Home Scale was used as the measurement tool. Confirmatory factor analysis, reliability–validity analyses, measurement invariance, and paired-samples t-tests were applied. The findings show that the bodily home difference was not statistically significant at the conventional 0.05 threshold, whereas primary-home scores were significantly higher in the material, vibrant, imaginary, and emotional home dimensions. The small to small-medium effect sizes suggest that the results should be interpreted cautiously as an asymmetrical home-building process rather than as evidence of a hierarchical superiority of the primary home. The study proposes a planning approach that does not view second home owners as merely transient consumers in sustainable coastal–rural destinations, but rather considers social sustainability, service planning, seasonality management, and local community engagement channels together. Full article

This study examined rural pre-service teachers’ preferences for online learning platforms, Telegram, WhatsApp, and Moodle discussion forums in the Open Distance e-Learning environment. This group of students experiences digital illiteracy, limited access to assistive technologies, and network challenges, which may prevent them from optimally utilising formal learning platforms such as Moodle. They can, however, use Telegram and WhatsApp, as they regularly engage informally on these platforms. Against this backdrop, this study explored rural pre-service teachers’ experiences with Moodle and these social media platforms in an Open-Distance e-Learning space. This study employed a descriptive, qualitative case study with semi-structured interviews, guided by Siemens’ Connectivism theory. Fifteen student teachers from the College of Education in an ODeL institution were purposively sampled to provide in-depth insights into their lived experiences of platform use. The findings revealed that, although each platform served a unique instructional function, their perceived professionalism, safety, and interactivity differed substantially. Social media platforms such as Telegram and WhatsApp were lauded for their immediacy, accessibility, and low bandwidth usage, chiefly among rural pre-service teachers from economically disadvantaged communities. However, participants perceived these platforms as unprofessional, disruptive, and unsafe. Conversely, Moodle’s discussion forum was viewed as a credible, structured space that fostered academic discipline through the presence and guidance of lecturers. These contrasting perceptions highlight tensions between accessibility and academic regulation within ODeL environments. Although prior studies support incorporating social media platforms into LMSs, this research extends this discourse by emphasising the need to balance accessibility, interaction, and academic integrity within resource-constrained contexts. The study concludes that social media platforms and discussion forums can complement each other in ODeL, encouraging student interaction and inclusion, while discussion forums ensure educational rigour, safety, and institutional integrity. Full article

Existing thermal sensation prediction models typically examine the relationship between skin temperature and thermal sensation during cooling or heating seasons. However, due to significant fluctuations in indoor thermal environments during shoulder seasons and considerable individual variation in clothing preferences, traditional thermal sensation prediction models demonstrate poor predictive performance during shoulder seasons. This study aims to investigate the relationship between facial skin temperature and clothing insulation versus thermal sensation under shoulder seasonal conditions and to establish a predictive model for human thermal sensation influenced by clothing insulation. First, facial temperature data under different clothing conditions are collected online using infrared thermal imaging equipment. Subjective thermal sensations are obtained through questionnaires, enabling analysis of the influence of relationships among clothing insulation, facial temperature, and thermal sensation. Subsequently, correlation analysis is used to identify the facial temperature zones closely related to human thermal sensation. Finally, a random forest algorithm is employed to establish a thermal sensation prediction model. Research findings indicate that during shoulder seasons, the left and right cheeks and lips exhibit a higher correlation with thermal sensation. Due to variations in clothing insulation, thermal sensation models based solely on facial temperature characteristics demonstrate lower predictive accuracy and struggle to overcome interference caused by individual clothing differences. After incorporating clothing insulation as a key input feature parameter, the model’s Root Mean Square Error decreased from 0.869 to 0.533, representing a 38.7% improvement in prediction accuracy. This demonstrates that the clothing insulation parameter plays a crucial role in enhancing the precision of human thermal sensation prediction models during shoulder seasons. Full article

With the rapid development of Artificial Intelligence (AI) technology, human-like AI service agents have been increasingly applied in service marketing. Online travel agency (OTA) platforms provide an important application context for such service agents in consumer-facing service interactions, such as travel planning and related services. Drawing on social cognitive theory and control theory, this study examines the psychological mechanisms underlying consumers’ intentions to adopt AI service agents. One pretest and two experiments involving 521 participants were conducted to investigate the effects of the AI service agent role on consumers’ willingness to use substitute vs. assist AI. The results show that consumers are more willing to use assist AI service agents than substitute AI service agents. This effect is mediated by human identity threat and sense of control. Moreover, higher consumer technology readiness moderates these effects, mitigating the preference for assist over substitute AI service agents. This study extends the conceptual framework of AI service agents in human–computer interaction research and offers practical implications for the effective design and deployment of AI service agents in OTA applications. Full article

Background/Objectives: Excessive screen time has become increasingly common among children worldwide. The current study investigated the relationship between adherence to recommended screen time guidelines and family and child characteristics and social development through play. This cross-sectional study examined the relationship between the appropriate use of screen time and family and child characteristics and aspects of social development through play in children aged 0–3 years. Methods: This cross-sectional study included 278 mothers from all five Brazilian geographic regions who answered two self-administered online questionnaires assessing sociodemographic characteristics, family characteristics, child development, and screen use in children aged 0–3 years. Analyses included descriptive statistics, chi-square tests, and logistic regression to identify factors associated with adherence to recommended screen time guidelines. Results: Male sex (OR = 3.306, 95% CI: 1.759–6.213), family characteristics (living with both parents, OR = 4.102, 95% CI: 1.134–14.836) and aspects of social development (playing with another child (OR = 2.410, 95% CI: 1.024–5.650); body-based exploratory play (OR = 2.941, 95% CI: 1.225–7.042); and playing with homemade toys (OR = 1.931, 95% CI: 1.032–3.623)) were associated with adherence to recommended screen time guidelines. Conclusions: Appropriate screen time use was associated with male sex, living with both parents, playing with peers, engaging in body-based exploratory play, and using homemade toys. Routine child health consultations must explore family characteristics and evaluate aspects of children’s social development to identify healthy screen use behaviors. Full article

Background/Objectives: Overweight and obesity are increasing globally. However, structured contemporary data on lifestyle behaviors and adiposity in Romanian young adults remain limited. Therefore, this study aimed to describe dietary and lifestyle habits, BMI, and overweight/obesity prevalence in Romanian adults aged 18–30 years and to examine associations between these variables. Methods: This cross-sectional online questionnaire study included 1202 young Romanian adults. BMI was calculated from self-reported height and weight and analyzed continuously, as well as for overweight/obesity (BMI ≥25 kg/m²). Pre-specified exposures were compulsive eating, soft-drink intake, breakfast frequency, physical activity, and sleep duration. Multivariable linear regression with heteroscedasticity-consistent standard errors was used for BMI, and modified Poisson regression with robust variance was used for overweight/obesity. Composite dietary score, sex-interaction, and sensitivity analyses were also performed. Results: Mean age was 23.2 ± 3.3 years, mean BMI was 23.8 ± 4.2 kg/m², and 32.4% of participants had overweight/obesity. Men had higher BMI and a higher prevalence of overweight/obesity than women. Compulsive eating and soft-drink intake showed dose-dependent associations with higher BMI and higher overweight/obesity prevalence. Short sleep duration (≤5 h/night) and daily breakfast consumption were associated with a higher and, respectively, lower prevalence of overweight/obesity. Physical activity showed no independent association after full adjustment, although this finding may be influenced by the use of a single self-reported item. Composite-score analyses supported the main findings. Conclusions: In Romanian young adults, compulsive eating and soft-drink intake were the most consistent behavioral correlates of adiposity, while breakfast regularity and short sleep showed threshold-type associations with overweight/obesity. These findings may inform the design of multicomponent prevention strategies, although longitudinal confirmation is needed. Full article

Adopting a circular economy approach requires new business models, multi-stakeholder engagement, and tailored financial models and mechanisms as core pillars. This paper examines the conditions needed to scale circular economy initiatives in Europe by analysing insights collected from the DECISO project and conducting a comparative analysis of 38 European projects. The study adopts a mixed methods approach that integrates an online stakeholder survey with inputs generated through participatory workshops and discussions of selected use cases. This combined approach is used to identify the main structural barriers limiting the maturity and investment readiness of circular economy projects, such as regulatory complexity, difficulties in accessing funding, and weak stakeholder dialogue mechanisms. The approach was also used for enabling factors that can support development of circular economy. Particular attention is given to the role of project development assistance, modular financing strategies, and de-risking tools, which are highlighted as crucial elements for supporting the technical and economic credibility of projects and attracting public and private investors. The article also identifies and addresses seven unresolved research gaps in the literature, including the lack of interoperable policy instruments, the absence of business models capable of integrating investor expectations, the paucity of integrated methodologies for assessing technical and economic regulatory feasibility, and the need for trust-building procedures. The findings suggest that the transition to a regenerative economy requires a systemic approach based on coherent policies, de-risking financial instruments, collaborative governance, and strategic technical support throughout the project development cycle. Full article

Artificial intelligence (AI) is increasingly being deployed in various sectors of e-commerce. Consequently, it becomes necessary to identify the impact of algorithmic design parameters on buyer behaviour. This study examines the impact of algorithmic anthropomorphism (ANT), algorithmic transparency (TRAN) and perceived algorithmic fairness (FAIR) on consumer purchase intentions (PI) in the Turkish e-commerce market. In addition, this study examines technology acceptance—operationalised through the Technology Acceptance Model (TAM)—as a boundary condition, with particular attention to the differential moderating roles of perceived ease of use (PEOU) and perceived usefulness (PU). A structured questionnaire was distributed among 384 online consumers in Türkiye via Qualtrics. A confirmatory factor analysis (CFA) established the psychometric adequacy of the measurement model (all AVE > 0.50, all CR > 0.87; HTMT < 0.85 across theoretically distinct constructs). The proposed model was tested using the PROCESS macro for sequential mediation and moderation analyses, with bootstrap confidence intervals based on 5000 resamples. The results reveal that: (1) algorithmic anthropomorphism positively affects both algorithmic transparency and perceived algorithmic fairness; (2) algorithmic transparency has a significant positive effect on both perceived fairness and purchase intention; (3) perceived algorithmic fairness mediates the relationships between algorithmic anthropomorphism and purchase intention, as well as between algorithmic transparency and purchase intention; and (4) although the composite technology acceptance level (TAL) measure does not significantly moderate the anthropomorphism–purchase intention path (p = 0.075), disaggregating TAL into its sub-dimensions reveals that PEOU significantly moderates this relationship (p < 0.001), whereas PU does not (p = 0.199). The composite-TAL result is therefore not statistically supported, but the dimension-specific PEOU finding is robust. These findings offer theoretical contributions to AI-driven consumer behaviour research and practical implications for the design of algorithmic e-commerce systems in emerging digital markets. Full article

The inner beauty functional food sector has grown rapidly in South Korea. These products are orally consumed bioactive formulations designed to improve skin health, hair vitality, and overall wellness. However, empirical evidence on consumption patterns and product format preferences across different demographic groups remains limited. This cross-sectional study examined consumption patterns, purchase channels, and product format preferences among 502 Korean adults who had experience with inner beauty functional foods. Chi-square analysis was used to examine differences in consumption reasons, duration of use, purchase channels, and product format preferences according to socio-demographic characteristics. Results showed that skin health was the dominant consumption motivation (47.6%), particularly among younger and female consumers, while weight management and hair and nail health were more prevalent among older adults. Online purchasing dominated (57.8%), with significant age- and education-based variation; consumers in their 20s purchased online at 67.5%, declining to 44.4% among those aged 40 and above. Capsule and tablet formats were most prevalent overall (41.6%), with males, married consumers, and graduate-degree holders showing significantly stronger preference for this format, whereas gummy and chewable formats were more frequently preferred by female consumers. These findings provide practical implications for inner beauty producers, food distributors, and nutrition educators seeking to align product development and communication strategies with the heterogeneous preferences of Korean inner beauty consumers. Full article

Background: Postpartum depression (PPD) is a common perinatal mental health disorder with important consequences for mothers and children. Early detection depends largely on primary and community healthcare professionals. This study assessed knowledge, recognition patterns, and screening practices related to PPD and examined factors associated with screening implementation. Methods: An exploratory cross-sectional online survey using convenience sampling was conducted between December 2025 and March 2026 among 154 healthcare professionals (74 community nurses and 80 physicians). Structured questionnaires assessed PPD knowledge, while physicians additionally reported screening and treatment practices. Group differences, correlations, and predictors of screening implementation were analyzed statistically. Results: Community nurses achieved higher overall knowledge scores than physicians (66.1% vs. 58.4%; p = 0.0038). Physicians more frequently distinguished baby blues from PPD (60.0% vs. 27.0%; p < 0.001). Awareness of validated screening tools among physicians was low, with only 10.0% recognizing the EPDS. Although physician knowledge correlated with screening frequency before correction for multiple testing (ρ = 0.27; p = 0.015), the association was not statistically significant after BH–FDR correction (q = 0.075). In multivariable logistic regression analysis, guideline awareness was not significantly associated with screening implementation (OR = 3.81; 95% CI 0.98–14.82; p = 0.053). Conclusions: Gaps remain in knowledge of PPD screening tools and treatment, particularly among physicians. The findings support the need for improved education, dissemination of clinical guidelines, and implementation support for standardized screening practices. However, given the exploratory convenience-sampling design and the lack of statistically significant adjusted associations, further longitudinal and implementation-focused studies are needed. Full article

Online reviews are increasingly pivotal in consumer decision-making, with platforms employing mechanisms such as badges to denote reviewer credibility. Although prior research has examined the influence of expert reviewers, it has typically treated badge holders as a homogeneous group, overlooking how variation in tenure within expert tiers shapes the way readers process review content. This article examines how Yelp Elite badge tenure, operationalized as Red (1–4 years), Gold (5–9 years), and Black (10+ years) tiers and treated as a proxy for accumulated platform-recognized expertise, moderates the effects of peripheral cues (Extremity, Length) and central cues (Readability, Subjectivity, and Plutchik’s eight emotions) on perceived helpfulness within an Elaboration Likelihood Model (ELM) framework. The analysis draws on the full population of 324,426 restaurant reviews authored by Yelp Elite badge holders between 2019 and 2021, using a pooled count-model specification with badge tier as a categorical moderator. The primary specification is estimated using Poisson quasi-maximum likelihood with HC1-robust standard errors, and full negative binomial estimation is reported as a robustness check. Wald tests indicate that badge tenure significantly moderates eight of twelve cue–helpfulness relationships (${\chi }^2\left(24\right)=4938$, $p<0.001$). The effect of readability is monotonically positive and increases sharply with tenure, while the effect of joy varies across tenure groups. These findings suggest that reviewer expertise signals are not monolithic, refining theoretical insights on how tenure-based credibility cues moderate cue processing and offering practical implications for review platform management. The findings also indicate that platforms applying uniform ranking or surfacing rules across all Elite reviewers risk misallocating visibility, and that tenure-conditional weighting of textual cues warrants consideration. Full article

This study analyzed online review data to examine user requirements for audiovisual products and to compare requirement salience and satisfaction across traditional and emerging product contexts. We collected 86,213 Chinese-language reviews of Skyworth TVs, Xiaomi TVs, and Xiaomi projectors from JD.com. LDA topic modeling was used to identify major user requirement areas, and Logistic Regression, Random Forest, and Support Vector Machine (SVM) models were compared for sentiment classification, with the tuned SVM model retained for downstream analysis. The results show that user discussions primarily concern audiovisual experience, cost performance, service quality, design aesthetics, and intelligent operation. Skyworth TVs receive particularly strong evaluations for picture and sound quality (97.89% positive sentiment), whereas Xiaomi TVs are more strongly associated with cost-effectiveness and smart features (94.05% positive sentiment). Xiaomi projectors attract attention for portability but receive lower satisfaction ratings on core audiovisual performance and intelligent operation. These findings suggest that traditional manufacturers should continue strengthening core performance while improving service responsiveness, whereas emerging brands should build on their technological advantages while further enhancing their product reliability and user experience. Full article

Background: Stroke is a major global health issue. It is among the leading causes of disability and mortality worldwide. Early stroke detection and treatment are significant in enhancing long-term outcomes. Awareness of neuroimaging is also essential because neuroimaging must be completed urgently within a limited time to diagnose and treat stroke patients correctly. This study aims to investigate awareness of stroke symptoms, risk factors, and utilization of neuroradiology services among the public in Saudi Arabia. Methods: This is an online survey study that was conducted in Saudi Arabia using social media platforms between January to February 2026. The questionnaire tool for this study was adapted from previous research and examined stroke awareness, symptoms, and risk factors. In addition, it examined neuroradiology awareness and utilization. The multivariable logistic regression analysis was used to identify predictors of better awareness of stroke. Results: A total of 415 participants were involved in this study. Around 46.7% of them were aged 25–34 years. Females formed the majority of the study sample, comprising 76.4%. Bachelor’s degree holders formed 61.4% of the study sample. Around 42.9% of the study sample were unemployed. Married participants contributed 64.3%. Almost half of the study sample (47.2%) reported that their monthly income is less than 5000 SAR. In this study, the participants demonstrated a moderate level of knowledge of stroke. The majority of the participants (70.8%) reported that they are aware of radiology centers near them that they can refer to in case of stroke emergency or follow-up, and 79.0% reported that they think that radiological imaging is important for diagnosing and treating stroke. The majority of the participants (72.3%) reported that they have heard of interventional radiology procedures for stroke. Participants aged 35–44 years and 55–64 years were less likely to have better knowledge of stroke compared to others (aOR: 0.21 (CI: 0.06–0.83); p-value: 0.026) and aOR: 0.17 (CI: 0.04–0.81); p-value: 0.026, respectively). Furthermore, participants who reported that their income level is 5000–9999 SAR and 10,000–14,999 SAR were less likely to have better knowledge of stroke compared to others (aOR: 0.32 (CI: 0.13–0.80); p-value: 0.014 and aOR: 0.21 (CI: 0.09–0.53); p-value: <0.001), respectively). On the other hand, participants who are unemployed were more likely to have better knowledge of stroke compared to others (aOR: 3.63 (CI: 1.09–12.05); p-value: 0.035). Conclusions: The current investigation demonstrated a moderate level of knowledge about strokes among the public in Saudi Arabia. Targeted interventions are mandated to improve the level of awareness about strokes, with a focus on knowledge of the correct emergency response, specifically calling an ambulance. Full article