Search Results (58)

The purpose of this study is to evaluate the differences in sexual functioning in women who used cannabis before sex and those who used cannabis but not before sex, among those with sexual dysfunction. The cross-sectional study, conducted from August 2019 to January 2020 at an academic sexual dysfunction clinic in the Midwest region of the United States, included 187 participants. Patients completed an anonymous questionnaire during their visit, which included the Female Sexual Function Index (FSFI), cannabis use, and sociodemographic factors. The primary objective of this study was to assess the relationship between cannabis use and female sexual dysfunction (FSD). The secondary objective was to examine the FSFI domains of sexual function with cannabis use over the past four weeks. Among the participants, 90% (n = 168) had sexual dysfunction based on the FSFI scores among those with FSD. Women with FSD who used cannabis before sex reported significantly higher lubrication scores and trends toward higher arousal and total FSFI scores than those who used cannabis but not before sex. However, no significant differences were observed in sexual desire, satisfaction, or pain. Quality of life was statistically significant across cannabis groups, with those who never used cannabis indicating “very good to excellent” health more often than those who used cannabis before sex. In addition, women with FSD who had never smoked cigarettes had a significantly higher proportion of never having used cannabis compared to those who used cannabis not before sex and those who used it before sex. These findings suggest that women with sexual dysfunction who use cannabis before sex may experience improvements in lubrication, arousal, and overall sexual function, highlighting the potential benefits of cannabis use in enhancing specific aspects of sexual health in this population. Full article

This study explores the factors influencing Arab tourists’ intention to revisit Turkish destinations, contributing to the theoretical discourse on tourist behavior, destination loyalty, and sustainable tourism development. Over the past decade, Türkiye (Turkey) has experienced a steady increase in tourists, with Arab visitors forming a significant segment. This growing market segment presents unique opportunities and challenges that remain understudied in academic literature. Despite their prominence, limited research exists on Arab tourists’ behavior, needs, and experiences in Türkiye. This study employs a mixed-method approach, combining surveys and interviews conducted between July and December 2024. Data from 713 surveys and 14 interviews were analyzed, revealing that 72% of Arab tourists were satisfied with their current visit, 49% with previous visits, 57% indicated a strong intention to revisit, and 81% recommended Turkish destinations to others. The study identifies seven key dimensions of revisit intention through Exploratory Factor Analysis that collectively explain 79.841% of the variance in revisit intention. The regression analysis demonstrates how different factors contribute to revisit decisions, with overall satisfaction (β = 0.622), loyalty (β = 0.521), financial status (β = 0.507), behavior of staff and locals (β = 0.484), cultural and social appeal (β = 0.478), overall experiences (β = 0.329), educational level (β = 0.333), accessibility and convenience (β = 0.288), service quality (β = 0.216), and length of stay (β = 0.128) emerging as significant predictors. These findings underscore the complexity of the decision-making process, suggesting that no single theory can fully explain tourists’ behavior and the sustainability of their visits. The study recommends further exploration of the proposed model and investments in tourism staff training, particularly in foreign languages, to enhance service quality and encourage repeat visits. Addressing issues such as unprofessional behavior and language barriers can improve overall satisfaction and loyalty, increasing the likelihood of Arab tourists revisiting Türkiye. This research highlights the importance of sustainable tourism practices in fostering long-term economic and social benefits for Turkish destinations. Full article

Background: Dental anxiety is a significant barrier to dental care, leading to avoidance behaviors and compromised oral health. This study aimed to analyze fear and anxiety during dental hygiene visits with Guided Biofilm Therapy (GBT), focusing on gender differences in psychological and physiological responses to develop a more personalized approach to dental care. Methods: A total of 247 patients participated in this study. Psychological assessments included the Modified Dental Anxiety Scale (MDAS) and the State-Trait Anxiety Inventory (STAI X2), while physiological responses were measured through heart rate monitoring before and after procedures. Multivariate regression analysis was conducted to identify predictors of anxiety levels. Results: Multivariate regression analysis identified gender, sensory sensitivity (e.g., absence of tools in the field of view), past traumatic dental experiences, and individual preferences for anxiety reduction as significant predictors of anxiety levels. Gender differences were also observed in anxiety management strategies, with women more frequently preferring the elimination of sensory triggers and direct communication with dental professionals. Conclusions: The findings highlight the importance of personalized anxiety management protocols in dentistry. Tailored communication strategies, optimized clinical environments, and individualized pre- and post-procedure care plans can enhance patient experience and treatment acceptance. Implementing such patient-centered, data-driven approaches aligns with the broader principles of precision medicine in dental care. Full article

Over the past several years, many iconic national parks in the US have experienced large increases in visitation. At the same time, lesser-known units have had declining numbers. Both issues challenge the sustainable management of parks. The purpose of this study is to use motivation theory to develop and test the differences between market segments at a western US national historic site. The ultimate goal is to contribute to sustainable visitation management by increasing visitation and enhancing the visitor experience. A market segmentation analysis can identify and describe promising target markets. The data were collected using an onsite exit survey, resulting in a sample of 570 visitors over the high season. Three clusters of visitors were identified: heritage immersers, history appreciators, and casual sightseers. The groups differed significantly with respect to visitation motives, travel, and visitation patterns. Segments are described and implications offered. The study confirms differences among cultural heritage visitors, with some being promising as target markets for the historic site. The study underscores the importance of tailoring site management and marketing strategies to meet the diverse needs of visitors and supports the use of motive-based segmentation as a means of better understanding and sustainably managing visitor experiences. Full article

Background/Objectives: The objective of this study was to investigate the factors influencing adherence with tuberculosis medication therapy. Non-adherence can result in treatment failure, ongoing infectiousness, and the development of drug resistance. Therefore, understanding the reasons behind non-adherence is crucial for achieving the World Health Organization’s target of 90% treatment success. Methods: Data were collected prospectively from a cohort at three different tuberculosis dispensaries (TBDs), with participants being followed up with at face-to-face visits every two months for a total of three visits. Results: In this study, the adherence rates among participants were the highest during the intensive treatment phase (81.0% at the first follow-up) but declined during the continuation phase, reaching 69.4% at the second follow-up (at the end of the fourth month of treatment) and 71.1% at the third follow-up (at the end of the sixth month of treatment) according to self-reports for the past 30 days. According to the generalised estimating equations method, factors significantly associated with better adherence included knowledge of infectiousness, daily access to medication, workplace permissions, high household income, regular sleep patterns, extrapulmonary TB, secondary education, and no alcohol consumption. Conclusions: Non-adherence with anti-TB medication has been observed in patients with TB, particularly during the continuation phase of treatment. Interventions targeting patients who experience frequent forgetfulness, adverse drug reactions, or a lack of workplace flexibility may help to improve adherence. In addition, providing personalised health education that highlights the risks of non-adherence and emphasises the infectious nature of TB could improve understanding and commitment to treatment. Ensuring regular follow-ups and support, particularly for those with lower socioeconomic status or limited social support, can further reinforce the importance of adherence in TB treatment outcomes. Full article

Background/Objectives: Hospitalization can be stressful for children due to the influence of unfamiliar environments, separation from family, and interactions with healthcare professionals. This study aimed to explore children’s hospitalization experiences from a child-centered care perspective to develop interventions that better meet their emotional and psychological needs. Methods: This qualitative study employed Husserl’s descriptive phenomenology to explore hospitalization experiences among children aged 9–13 years. Conducted at a primary health center in Spain from October 2022 to June 2023, the study used purposive sampling to select participants hospitalized within the past six months. Data were collected through in-depth interviews and children’s self-created drawings, analyzed using thematic analysis with ATLAS.ti software. Results: A total of 10 school-age children (five boys and five girls) were interviewed. Three main themes emerged: (1) Emotions and Feelings—children described fear, anxiety, and loneliness during their hospital stay; (2) Experiences of Pain and Discomfort—participants reported physical pain and discomfort; (3) Interactions with Medical Staff—children expressed a need for more detailed explanations and clearer communication. Conclusions: The findings highlight the importance of family-centered care and improved communication between healthcare providers and children. Strategies like art therapy and flexible visiting hours could provide better emotional support. Tailored communication to children’s developmental levels is crucial. Integrating these strategies into clinical practice could enhance the well-being of hospitalized children. Future research should focus on evaluating these interventions to improve pediatric care. Full article

Background/Objectives: Barriers to food pantry use have been identified but little information is available regarding how these barriers are related to food pantry use. The purpose of this study was to assess relationships between barriers and (1) user demographic characteristics, (2) visit frequency and amount of food received, and (3) satisfaction with pantry visit experiences. Methods: Data were used from the 2022 Minnesota Food Shelf Survey, which included responses from 288 food pantries across the state with 6267 individuals reporting on barriers to pantry use. Survey barrier statements included limits on frequency of visits allowed, lack of reliable transportation, scheduling difficulties, and other. Survey satisfaction statements included being able to choose food types, being made welcome, having an easy selection process, having different varieties of food available, and foods having a favorable appearance. Chi-square and mixed model logistic regression analyses were used to assess relationships between reporting barriers and demographic characteristics, visit satisfaction, visit frequency, and amount of food received in the past 6 months. Results: Respondents were primarily non-Hispanic White (65%) and female (68%). Regression models showed that reporting barriers to pantry use was not associated with user demographic characteristics, but was associated with greater odds of visiting the pantry more often, and lower odds of getting more food from the pantry or reporting a satisfactory food pantry visit experience. Conclusions: Findings may be useful for food pantry staff to improve pantry access and visit experiences and for public health professionals who advise those who use food pantries to supplement household food supplies. Full article

The main purpose of this study is to analyze how stakeholders’ perceptions of sustainable land use and the management of natural parks affect land management planning, with a focus on park visitors. This study was carried out in July 2019, during a period of high visitor numbers at the Belgrade Forest nature parks, as reported by the park manager. It involved evaluating participants’ knowledge about the specific natural park they visit and the organization managing it. The results show that the mode of transportation significantly influences this knowledge. Visitors who walked or drove to the park demonstrated a greater understanding of the park and its management. A visit to a nature park typically involves anticipation, planning, the visit itself, participating in activities, returning, and reflecting on past experiences. Visitors are drawn to the Belgrade Forest nature parks because of their cleanliness, family-friendly atmosphere, peacefulness, proximity, uniqueness as a green space in Istanbul, wooded areas, and suitability for sports. The study also reveals that the characteristics of nature parks, such as park amenities, distance, transportation options, and reasons for visiting, contribute to visitors’ happiness, especially affecting younger visitors between the ages of 19 and 30. These findings highlight the varied nature of visitors’ impressions after their visit, depending on their individual characteristics. In conclusion, this detailed analysis offers valuable insights to guide strategic park management efforts aimed at promoting sustainability and enhancing visitor experiences in the Belgrade Forest areas of Türkiye. Full article

Evolution by natural selection is believed to be the only possible source of spontaneous adaptive organisation in the natural world. This places strict limits on the kinds of systems that can exhibit adaptation spontaneously, i.e., without design. Physical systems can show some properties relevant to adaptation without natural selection or design. (1) The relaxation, or local energy minimisation, of a physical system constitutes a natural form of optimisation insomuch as it finds locally optimal solutions to the frustrated forces acting on it or between its components. (2) When internal structure ‘gives way’ or accommodates a pattern of forcing on a system, this constitutes learning insomuch, as it can store, recall, and generalise past configurations. Both these effects are quite natural and general, but in themselves insufficient to constitute non-trivial adaptation. However, here we show that the recurrent interaction of physical optimisation and physical learning together results in significant spontaneous adaptive organisation. We call this adaptation by natural induction. The effect occurs in dynamical systems described by a network of viscoelastic connections subject to occasional disturbances. When the internal structure of such a system accommodates slowly across many disturbances and relaxations, it spontaneously learns to preferentially visit solutions of increasingly greater quality (exceptionally low energy). We show that adaptation by natural induction thus produces network organisations that improve problem-solving competency with experience (without supervised training or system-level reward). We note that the conditions for adaptation by natural induction, and its adaptive competency, are different from those of natural selection. We therefore suggest that natural selection is not the only possible source of spontaneous adaptive organisation in the natural world. Full article

Study Design: Retrospective chart review. Objective: Socioeconomic status (SES) greatly impacts one’s health status and the type of trauma that a patient experiences due to increased risk of exposure and varying availability of resources to treat emergent conditions. There is a need for large-scale databases of pediatric facial trauma to identify discrepancies in occurrence and identify risk factors. Methods: This retrospective examination uses a multi-center database to evaluate pediatric facial trauma patients (n = 644) visiting Atrium Heath Wake Forest Baptist (AHWFB) hospital from 2020 to 2022. Data collected included demographic information, past medical and surgical history, trauma history, interventions, and long-term outcomes such as scarring, deformities, and sensory or motor deficits. The number of incidents for each zip code surrounding AHWFB was compared with SES data including unemployment rate, mean household income, and poverty level. Results: Thirty-five percent of patients sustained a high-energy injury, and 65% sustained a low-energy injury. Within the surrounding counties of AHWFB, there were more incidents of pediatric facial trauma in areas with greater rates of poverty (p = 0.006). Additionally, there were more incidents due to high-energy injuries in areas with lower income (p = 0.044) and more poverty (p = 0.002). Specifically, motor vehicle accidents were more common in areas with lower income (p = 0.017) and more poverty (p = 0.001). Conclusions: These findings in the central Piedmont region of North Carolina are consistent with previous research of SES’s effect on health inequalities and serve as evidence of the need to take steps to prevent pediatric facial trauma in areas of low SES. Full article

Starting from the critical premises that underpin the debate between archeology and architecture, some evidence emerges: sometimes, the musealization of buildings, “urban carcasses” and historical ruins—which are our legacy from the past—is even more harmful than that of any other artefact, for the purposes of their real understanding. In a country like Italy, which has archeological presences more than any other, architecture must contribute to overcoming the consolidated aporia that the Contemporary, conceived not only as a period but also and above all as its “forms and functions”, is structurally in opposition to the conservation of archeological heritage. Spatium ad Omnes, the project presented in this article, is an attempted exercise at “inhabiting archaeology”, that is, trying to re-grant inclusive usability to a historical fragment, which has lost the elements necessary for its liveability, paying attention to the reversibility of the project itself. The set of questions, doubts and steps preliminary for the design have been highlighted more than the final “figure” of the project: an essential form directly connected with the primordial principles of its constitution. Spatium ad Omnes protects and encourages visiting the complex, trying to offer new perspectives, new narratives and new connections that translate into the possibility of being—for those who visit this place—the protagonists of a unique experience made of history, memory and continuous discoveries. Full article

Quality care in healthcare is a multifaceted concept that encompasses the execution of effective medical treatments and the patient’s overall experience. It involves a multitude of factors, including effectiveness, safety, timeliness, equity, and patient centeredness, which are important in shaping the healthcare landscape. This cross-sectional study used the data from the Health Information National Trends Survey 6 (HINTS 6), which collects data on various aspects of health communication and information-seeking behaviors, to investigate the factors associated with quality care among White and Hispanic populations. All adults who participated in HINTS 6 and visited healthcare service at least once in the past 12 months were included in this study. Multivariable logistic regression was used to determine the association between quality care and delay or discriminated care with the adjustment of all other sociodemographic variables. We analyzed a total of 3611 participants. Poor social determinants of health (SDOHs) (OR 0.61, CI 0.43–0.88, p = 0.008), delayed needed medical care (OR 0.34, CI 0.26–0.43, p < 0.001), and discriminated care (OR 0.29, CI 0.15–0.54, p < 0.001) were all negatively associated with optimal quality care. Negative SDOHs could also be positively associated with delayed care and discriminated care. Full article

Hispanic and American Indian (AI) women experience lower breast cancer incidence than non-Hispanic White (NHW) women, but later-stage diagnoses and lower survival rates, suggesting issues with screening and healthcare access. Between 1999–2015, NHW breast cancer incidence decreased by 10% but increased by 8% for AI women. This study used 2016 and 2018 Behavioral Risk Factor Surveillance System data for Arizona and New Mexico to explore mammography screening. Analyses included Hispanic, AI, and NHW women aged ≥40 years (n = 12,830) to calculate age-specific compliance by race/ethnicity, logistic regression, and adjusted and sample-weighted evaluated associations between compliance and socio-economic covariates. In total, 75.1% of Hispanic women aged 50–74 reported mammography in the past two years (United States Preventive Services Task Force compliant) compared to 73.9% of NHW and 71.0% of AI women. Women who reported doctor visits in the past 12 months were likelier to comply than those without (AOR = 4.2 for Hispanic, 2.9 for AI, and 3.2 for NHW women). Reporting access to a personal doctor was related to compliance, except for AI women. While screening compliance was over 74%, visiting a healthcare provider in the past 12 months was essential. AI women reported issues that suggest unique challenges when deciding on mammography. Full article

The port, fortresses, and monuments of Cartagena were included in the UNESCO World Heritage list in 1984. Nevertheless, since 2017 they are threatened to be categorized as “in Danger” by UNESCO. This research analyzes two main critical aspects, governance and the current state of the site. This study applies an innovative interdisciplinary methodology that merges empirical and scientific approaches to evaluate the governance of Cartagena’s heritage (causes) and its impact on the current state of the tangible cultural heritage (effects). Methodologically, secondary information is used to study governance. The study aims to identify strengths, weaknesses, opportunities, and threats in the UNESCO site governance. Exemplary heritage management systems are studied to propose an adaptable management approach specifically for Cartagena. Over the past five years, qualitative data collected through field observations, along with a photographic report, have revealed significant issues stemming from insufficient heritage management. These problems have rarely been addressed in the existing literature. Furthermore, a quantitative approach was taken by analyzing hyperspectral images obtained from a previous study to identify vegetation and asbestos-cement roofs within the cultural heritage site. It takes a unique perspective by investigating the root causes rather than superficial issues. The study comprehensively analyzes various factors, including material degradation, vehicular traffic, environmental elements, urban structure, and architectural integrity, forming an interconnected framework with governance problems. This research offers a broader perspective that considers complex reality and goes beyond isolated problems and solutions. The study reveals that the ambiguity surrounding decision-making authority for heritage management, distributed between the Mayor’s Office and the Ministry of Culture, is a primary challenge. The lack of coordinated action significantly compromises the conservation and protection of the cultural heritage Site. Moreover, twelve current shortcomings of cultural heritage in Cartagena are identified through the authors’ five-year on-site regular visits, photographic reports, and observation. To address the prevailing concerns, a new line of command for cultural heritage management is proposed as the most effective means of tackling these challenges. Additionally, general recommendations are presented to mitigate the existing problems and prevent the classification of Cartagena’s heritage as “at risk” by UNESCO in the near future. Although, each problem identified would need a research project ad hoc to be fully addressed. This research provides a scientific perspective, drawing upon years of experience studying heritage and residing in the city, devoid of political influences or conflicts of interest. Full article

Over the past decade, many national park units in the United States broke visitation records. Arches National Park (UT, USA) is no exception. Between 2011 and 2021, visitation increased 74%. As part of considering management options to address the issues from sustained and concentrated visitation, Arches implemented a pilot timed entry system from 3 April to 3 October 2022. This article compares visitor perceptions, characteristics, and support for management actions before and during the pilot timed entry system using data from visitor intercept surveys. Findings suggest visitors experience quality improved across the park and on hiking trails during the pilot timed entry system. Visitor characteristics were extremely similar, and there were no differences in local residency, group size, vehicle occupancy, race, ethnicity, first time visitation, education level, or household income. Visitors were more likely to plan for the trip further in advance and were less likely to re-enter the park during the pilot timed entry system. Lastly, visitors demonstrated more support for timed entry and lower levels of support for expanding parking, site specific reservations, and temporary closures during the pilot timed entry system. These results reflect unique insights for managers considering managed access systems like timed entry to sustainably manage visitor use in parks and protected areas. Full article