Search Results (1,180)

Chronic obstructive pulmonary disease (COPD) imposes a substantial physical and psychosocial burden, yet the role of loneliness remains under-recognised in clinical practice. Loneliness, defined as a subjective discrepancy between desired and actual social relationships, has emerged as a clinically relevant determinant of patient outcomes. This narrative review synthesises current evidence on the epidemiology, mechanisms, and clinical consequences of loneliness in COPD, and evaluates its implications for disease management. Available evidence indicates that loneliness affects a considerable proportion of individuals with COPD, with prevalence estimates ranging from approximately 18% to over 30%, particularly among patients with greater symptom burden, functional limitation, and oxygen dependence. Dyspnoea and advancing disease severity reduce social participation and increase vulnerability to perceived social disconnection. Loneliness influences COPD outcomes through interconnected behavioural, biological, and healthcare engagement pathways, including systemic inflammation, neuroendocrine stress responses, physical inactivity, impaired self-management, and reduced engagement with healthcare services. These mechanisms contribute to poorer clinical trajectories, as loneliness is consistently associated with reduced health-related quality of life, increased exacerbations, higher healthcare utilisation, greater risk of hospitalisation, and elevated mortality, independent of depression and anxiety. Despite this, loneliness is rarely assessed in routine respiratory care, and targeted interventions remain limited. Emerging strategies, including pulmonary rehabilitation, peer support, and digital health interventions, show promise in reducing loneliness and improving outcomes. Loneliness represents a modifiable and clinically actionable risk factor in COPD, and its integration into routine assessment and management may enhance patient engagement, optimise treatment effectiveness, and reduce healthcare burden. Addressing loneliness represents a critical opportunity to advance more effective and comprehensive COPD care. Full article

Background: Parents of children undergoing liver transplantation face substantial caregiving demands that may adversely affect their mental health across multiple domains. Systematic evaluation of psychosocial outcomes in this population remains limited, particularly in settings that include immigrant families. Method: This was a single-center, cross-sectional study including the parents of 50 children after liver transplantation. Major sociodemographic variables included parental age, sex, education, chronic disease, and immigration status. We also recorded children’s demographics, transplant-related data, follow-up findings, and mental health status. Instruments for psychiatric assessment included the Generalized Anxiety Disorder 7-item scale (GAD-7; anxiety), Patient Health Questionnaire-9 (PHQ-9; depression), Perceived Stress Scale-10 (PSS-10; stress), and Pittsburgh Sleep Quality Index (PSQI; sleep quality). Results: We enrolled 50 parents of 50 pediatric liver transplant recipients (43 Turkish citizens, 7 Syrian immigrants; 28 fathers, 22 mothers; mean age: 40.10 ± 6.65). Time since transplantation showed weak negative correlation with PHQ-9 and GAD-7. Stress (PSS) levels had weak to strong positive correlation with PSQI, PHQ-9, and GAD-7. Sleep quality (PSQI) was positively correlated with PHQ-9 and GAD-7. Depressive findings (PHQ-9) were strongly and positively correlated with GAD-7. In Firth-penalized multivariable models, high PHQ-9 scores were independently associated with shorter time since transplantation (p = 0.001) and high PSS (p = 0.003). High GAD-7 scores were independently associated with shorter time since transplantation (p = 0.025) and high PSS (p = 0.001). Conclusions: The parents of pediatric liver transplant recipients experience high levels of stress, sleep issues, depression, and anxiety, which demonstrate multiple correlations. Full article

As the inner driving factor of space vitality, environmental perception can be expressed in many ways. Given the current lack of in-depth research on related perceptions, the study integrated theoretical origin and empirical study methods to clarify the role that preference played as the common foundation of different expression ways of environmental perception. The study also explored the interaction mechanism of different preference expression ways in the “quality-to-vitality” pathway and significant environmental characteristics of them, so as to realize the transformation from landscape design to urban vitality. Key findings indicate that: (1) Three environmental preference expressions—emotion, satisfaction, and behavioral preference—collectively lend credence to a significant chain mediation pathway (“emotion → satisfaction → behavioral preference”) in the quality-to-vitality process; (2) Pedestrian safety infrastructure (e.g., traffic barricades, well-maintained pavements) could ensure perceived security and walking activities; (3) Cultural/recreational facilities mean complementary legibility-enhancing elements (appropriate spatial enclosure, pleasant color schemes, architectural coherence) to evoke positive affect; (4) Streetscape diversity and visual interest might mitigate monotony induced by excessive block length, serving as vital vitality catalysts in some degree. Full article

With the proliferation of digital platforms, virtual brand communities have become important contexts for examining how individual perceptions shape discretionary behaviors in online environments. However, the mechanisms through which user experience translates into value co-creation behaviors remain underexplored. Drawing on relationship marketing theory and a behavioral perspective, this study develops and tests a theoretical model linking user experience to value co-creation citizenship behaviors through distinct dimensions of quality of relationship-satisfaction, trust, and commitment. Using a two-wave survey with 549 matched responses, we employ multiple regressions and bootstrapping analyses to assess mediation and moderation effects. The findings indicate that different dimensions of user experience have differential impacts on satisfaction, trust, and commitment, which in turn promote value co-creation citizenship behaviors, supporting their roles as central psychological mechanisms. Specifically, affective and behavioral experiences exert significant positive impacts on value co-creation citizenship behaviors, mediated by all three dimensions (satisfaction, trust, and commitment), whereas the influences of sensory and intellectual experiences are only mediated by two dimensions (satisfaction and trust) of the quality of relationship. In addition, perceived community support strengthens the relationship between satisfaction and value co-creation citizenship behaviors, while it exerts no significant moderating effects on the impact of trust or commitment on value co-creation citizenship behaviors. By situating value co-creation within a behavioral framework, this study contributes to the literature by exploring the mechanism through which user experience influences voluntary, citizenship-like behaviors in digital communities from a relational perspective, and by identifying boundary conditions under which these effects are amplified. Full article

Increasing use of intrauterine devices (IUDs) makes effective pain management essential for high-quality care. However, gaps between patient and clinician pain perceptions, along with limited training in managing IUD-related acute pain, contribute to barriers in IUD use and patient–provider mistrust. This narrative review aims at (1) summarizing current IUD-related pain management, (2) evaluating the emphasis on pain education and management, including IUD insertion pain, in medical education, and (3) examining how gaps in pain education and management may affect clinicians’ preparedness to manage patients’ IUD-related pain. Relevant literature was identified through keyword searches across major databases and national organizations. Studies on IUD pain management approaches and pain education in undergraduate medical education (UME), graduate medical education (GME), and residency programs were included. The results section outlines the current IUD insertion pain-management options available and their limitations, alongside evidence of insufficient emphasis on pain education and its management in medical school and residency training. In conclusion, the study indicates that, although all pain-management approaches reduce perceived IUD-related pain, significant gaps in national guidelines, clinician–patient pain-perception non-alignment, and pain-education across UME and GME may be contributary to inconsistent clinical practices. A multi-pronged approach that includes strengthening pain-education throughout medical training could be one way to reduce these disparities by improving clinicians’ competence to manage pain effectively. Full article

Background/Objectives: An arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis (HD). Beyond its clinical function, an AVF creates visible bodily changes that may affect identity, social positioning, and psychological adaptation. Women undergoing HD via an AVF may perceive these changes in relation to sociocultural expectations surrounding body image and gender roles. This study explored the lived experiences of women undergoing HD via an AVF and considered the implications for AVF management. Methods: Using Colaizzi’s descriptive phenomenological method, in-depth interviews were conducted with nine women undergoing regular HD via an AVF in South Korea. The data were analyzed to identify essential themes and the fundamental structure of their experiences. Results: The essential structure was described as “women’s lives shaken and repositioned amid visible, life-sustaining bodily changes.” Three interrelated theme clusters emerged: shaken self-confrontation of the visible body; being repositioned within the relational world; and acceptance formed within the polarity of life and threat. The visibility of the AVF influences identity, autonomy, and social interactions. Conclusions: AVF management should extend beyond technical maintenance and include psychosocial assessments and sex-sensitive supportive strategies. Addressing the visible and relational dimensions of the AVF may enhance the quality and safety of HD care. Full article

As the 2022 Curriculum for Wales becomes embedded in schools, this paper shares findings of a self-report survey from over 300 secondary school teachers on the nature, content and frequency of their curriculum conversations with other teachers. This new curriculum framework, grouping subjects together into Areas of Learning and Experience [AoLEs] enables disciplinary, interdisciplinary and multidisciplinary learning. Teachers reported on perceived factors affecting the quality of their dialogues and perceived opportunities for deepening interdisciplinary dialogue. Descriptive analysis shows teachers reported more conversations with other teachers in the same subject, more conversations about content taught rather than the purpose of teaching it and fewer conversations about how their subject relates to other subjects. Crucially, surface-level conversations were reported as more common than deeper conversations. The findings reveal processes and possibilities of curriculum policy enactment at the level of teacher professional discourse. Teacher–teacher dialogue, as a way of becoming aware of the purpose of other subjects and becoming more articulate in describing the purpose of one’s own, is highlighted as a necessary phase before teachers engage in collaboration. Deeper dialogue is proposed as a necessary precondition of deep and meaningful interdisciplinary collaboration. Full article

Daylighting in shopping-mall atriums affects both perceived visual quality and the availability of daylight for reducing electric-light use under daylight-responsive control. However, early-stage atrium design still lacks a reproducible workflow that connects field-based user-response evidence with parametric daylight simulation in retail settings. This study develops a weighted-sum design-search workflow for shopping-mall atrium morphology by combining a luminance-based visual satisfaction proxy with spatial daylight autonomy (sDA_300/50%) as an annual daylight-sufficiency indicator. Morphological parameter ranges were derived from a survey of 150 atriums in 26 shopping malls in China, and three prevalent atrium types were retained for simulation-based testing. ClimateStudio/Radiance simulations were used to calculate scene mean luminance and sDA_300/50%, and particle swarm optimization was used as a practical search algorithm under a fixed baseline weighting scenario. The reported high-scoring solutions reached sDA saturation, indicating that the final score differences were mainly governed by the luminance-based satisfaction term within the high-daylight-sufficiency region. This study contributes a retail-oriented, reproducible design-search workflow for early-stage atrium morphology decisions, while the results should be interpreted as scenario-based preferred solutions rather than statistically confirmed global optima or a complete visual-risk/energy-performance assessment. Full article

Water utilities are increasingly expected to combine technical reliability with social inclusion, risk communication, and service continuity. This empirical paper reports a cross-sectional mixed-mode household survey conducted in Rzeszów, Poland, based on 384 complete questionnaire records. For a city of approximately 200,000 inhabitants, this sample size matched the conventional planning benchmark associated with a 95% confidence level and a 5% maximum error under simple-random-sampling assumptions; however, because recruitment was mixed-mode and non-probabilistic, the results are interpreted as evidence from the realized sample rather than as formally weighted population estimates. The questionnaire covered routine service evaluation, interruption experience, preparedness, communication preferences, vulnerability-related burden, and willingness to support reliability enhancement. The analytical workflow combined descriptive statistics, reliability analysis, Bartlett’s test of sphericity, the Kaiser–Meyer–Olkin measure, principal component analysis, Mann–Whitney U tests, Kruskal–Wallis tests, chi-square tests, Spearman correlation, binary logistic regression, correspondence analysis, and CHAID-type segmentation. The highest ratings were recorded for continuity of supply (mean = 4.18) and pressure stability (mean = 4.15), whereas price fairness received the lowest mean score (3.17). Interruptions were reported by 40.1% of respondents and were associated with lower overall satisfaction. Logistic regression showed that continuity rating (OR = 4.029) and water quality rating (OR = 2.305) increased the odds of high satisfaction, whereas longer interruptions reduced them (OR = 0.354). Additional analyses showed that interruptions lasting 12 h or more markedly increased the odds of high nuisance among affected households (OR = 5.914), while respondents aged 51 years or more had lower odds of declaring emergency-information awareness (OR = 0.468). Internal bootstrap validation indicated only mild optimism (optimism-corrected AUC = 0.825). The findings indicate that customer satisfaction in urban water services is shaped primarily by continuity, perceived water quality, and disruption burden, while communication and preparedness needs remain socially differentiated. Full article

Objective: This study aimed to assess quality of life (QoL) and its determinants among Saudi adults diagnosed with type 2 diabetes mellitus (T2DM). Methods: A cross-sectional study was conducted among 200 (45% male and 55% female) Saudi adults with T2DM aged 30–65 years. Data were collected using the Audit of Diabetes–Dependent Quality of Life (ADDQoL) and the Personal Diabetes Questionnaire (PDQ). Anthropometric and clinical measures included weight, height, body mass index (BMI), blood pressure, and glycated hemoglobin (HbA1c). Results: Most participants (73.5%) were ≤50 years of age, and the majority were obese (56.0%) or overweight (28.0%). Nearly half (54.5%) had HbA1c levels ≥ 8.0%, while (50.5%) were hypertensive. Overall, 96% of participants reported a poor to extremely poor QoL. Female sex (p = 0.003), higher BMI (p = 0.034), diet type (p = 0.039), and satisfaction with glucose control (p < 0.001) were significantly associated with the QoL. Conclusions: T2DM substantially impairs the QoL of affected Saudi adults. Psychosocial and lifestyle-related factors, particularly obesity, gender, dietary practices, and perceived glucose control, are more influential than traditional clinical markers. Culturally tailored interventions targeting these determinants may improve patient outcomes. Full article

Background/Objectives: The digital transformation of healthcare has become a key component of building resilient and sustainable health systems. However, the long-term sustainability of digital health technologies depends not only on user acceptance but also on the institutional governance conditions that shape how these technologies are implemented and utilised in practice. This study examines how institutional factors shape the sustainable utilisation patterns of Internet of Things (IoT) technologies in regulated healthcare environments, with hospital IoT-based asset management systems, a mature and widely deployed use case in China’s public hospitals, providing the empirical context for the investigation. Methods: Drawing on institutional theory and the Technology Acceptance Model (TAM), we conceptualise user perceptions as behavioural micro-foundations through which institutional conditions influence technology utilisation. A survey of 293 healthcare professionals from two large public hospitals in China was analysed using Structural Equation Modelling (SEM), incorporating mediation and Multi-Group Analysis (MGA). Results: The results demonstrate that technical compatibility (TC) significantly enhances perceived ease of use (PEU) (β = 0.40), while organisational support (OS) positively influences both perceived usefulness (PU) (β = 0.35) and PEU (β = 0.30). Conversely, regulatory compliance (RC) negatively affects PU (β = −0.25) and PEU (β = −0.20), revealing a tension between accountability requirements and operational efficiency. The model explains between 58% and 67% of the variance in key constructs. Conclusions: Overall, the findings indicate that sustainable utilisation patterns depend on alignment between technological capabilities and institutional governance conditions, with user perceptions operating as behavioural micro-foundations through which institutional effects are transmitted. By integrating institutional theory with technology acceptance research, this study contributes a governance perspective for understanding sustainable digital transformation in healthcare systems and provides practical insights for designing interoperable, compliant, and supportive digital health infrastructures to enhance hospital operational efficiency and quality of care. Full article

Revisit intention is increasingly recognized as a key indicator of sustainable heritage tourism, as it reflects long-term visitor engagement rather than one-time consumption. However, limited attention has been paid to how tourism preferences shape perceived heritage quality and subsequently influence revisit intention, particularly in industrial heritage contexts undergoing urban regeneration. This study develops a structural model linking tourism preferences, perceived quality, and revisit intention, using Shanghai’s waterfront industrial heritage as an empirical case. Based on 335 valid questionnaires, structural equation modeling (SEM) is employed to examine the relationships among environmental preference, cultural and social sustainability preferences, situational perception, and behavioral intention. The results indicate that preference for a sustainable public space environment significantly enhances both physical and atmospheric perception, which in turn positively affects revisit intention. In contrast, social sustainability shows limited influence, suggesting that visitors’ behavioral responses are more strongly driven by environmental quality and experiential engagement in regenerated industrial heritage settings. This study contributes to sustainable heritage tourism research by integrating preference-based perception mechanisms into revisit intention analysis. It also provides practical implications for enhancing long-term attractiveness through experience-oriented adaptive reuse strategies. Full article

Academic stress is prevalent among university students and affects their evaluation of educational environment quality, fairness, and supportiveness. Based on the challenge–hindrance stressor framework and transactional stress-coping model, this study explores how challenge and hindrance stressors (HSs) shape perceived decent education (DE), focusing on the mediating role of artificial intelligence use (AIUSE) and moderating effect of interpersonal interaction (II). Using partial least squares structural equation modeling (PLS-SEM) to analyze survey data from 520 university students, the results show that both stressors positively predict AIUSE, which in turn improves perceived DE and mediates the stressor-DE relationship. II negatively moderates the AIUSE–DE link: the positive effect weakens as II increases. Moderated mediation analysis indicates that the indirect effects via AIUSE are only significant at low II levels. These findings highlight AI-enabled learning as an adaptive coping strategy and the necessity of integrating technological and interpersonal resources to enhance student well-being in higher education. Full article

The indoor microclimate of museums plays an essential role in preserving priceless cultural heritage for future generations and in ensuring visitors’ comfort and health. In this context, the present study aimed to evaluate indoor air quality, the degree of fungal contamination, and visitors’ perceptions in a museum environment through an integrated, interdependent approach. Measurements of the physicochemical parameters of air quality (temperature, relative humidity, CO₂, TVOC, HCHO, PM_2.5 and PM₁₀, negative and positive ions and brightness) were carried out in three exhibition halls within a museum in Oradea, Romania, during the period January–August 2024. Fungal contamination was assessed using surface and air samples, with classical isolation and microscopic identification methods. Visitors’ perceptions were analysed using a standardised questionnaire that focused on perceived comfort and visit duration. The results showed that the parameters defining indoor air quality generally fell within the limits set by the international standards in force, with occasional exceedances. These conditions are associated with the presence of fungi of the genera Cladosporium, Penicillium, and Aspergillus in the air and on museum exhibits, which pose risks to human health and the deterioration of the exhibited materials. The statistical decision-making model determined the critical thresholds above which visitor behaviour changed visibly. The results highlighted the importance of maintaining a stable microclimate in museum spaces, not only for the protection of exhibits, but also for optimising the cultural experience. Indoor air quality indicators and fungal microflora can only affect vulnerable people or those with pre-existing conditions. Occasional visitors do not present a significant risk of developing new conditions, considering the limited duration of exposure. Full article

Background/Objectives: Severe brain injuries generate complex, long-term needs requiring intensive physical, cognitive and relational care. These conditions also profoundly affect families, who often experience emotional distress, uncertainty and a heavy caregiving burden. Although neuro-palliative care is increasingly recognised, the early integration of palliative care for this population remains limited. This study aimed to explore healthcare professionals’ perceptions of the palliative care needs of patients with severe brain injuries and their caregivers and to identify factors that hinder or facilitate early palliative care implementation in specialised settings. Methods: An interpretive qualitative study was conducted using Reflexive Thematic Analysis. Fifteen semi-structured narrative interviews were carried out with healthcare professionals working in specialised hospital units in Northern Italy. Data were analysed inductively through an iterative and reflexive process following Braun and Clarke’s six phases. Methodological rigour and transparency were ensured using the COREQ checklist. Results: Five themes were identified: (1) intensive, individualised patient care needs with complex communication issues; (2) palliative needs centred on dignity, quality of life and early integrated management; (3) caregivers’ involvement and expectation-related difficulties; (4) continuous or anticipatory grief requiring structured psychological support; (5) facilitators and barriers influencing care pathways. Conclusions: Healthcare professionals identify intertwined and evolving palliative care needs in both patients with severe brain injuries and their families. The findings highlight the perceived importance of early, integrated and multidisciplinary neuro-palliative care models focused on dignity, symptom relief and sustained emotional support. Full article