Search Results (2,756)

Background/Objectives: Artificial intelligence (AI) is increasingly being used in medicine to improve the efficiency, accuracy, and timeliness of patient care. In prehospital tele-emergency medicine, AI also has the potential to address various challenges and support tele-emergency physicians. This study focuses on a specific AI-based decision support system being developed for use by practitioners. While technical feasibility is a prerequisite for the successful implementation of this system, social, ethical, and patient-centered considerations are equally important. Methods: The acceptance and perceptions of the German public, as potential patients, regarding the implementation of a specific AI system for prehospital tele-emergency medicine were assessed through an online survey. The results provide qualitative and quantitative insights into participants’ attitudes and acceptance. Results: The perceived advantages and disadvantages of implementing AI in prehospital tele-emergency medicine, as seen by potential patients, were identified, along with moderate acceptance of the technology. Participants emphasized the importance of different factors, including time efficiency, safety, AI recommendation accuracy, responsible system use, data and legal protection, technical stability, and positive impact on physicians’ work and patient outcomes. Conclusions: The findings enhance understanding of public perceptions regarding the use of AI in prehospital tele-emergency medicine and provide a valuable bioethical foundation for guiding the responsible integration of AI into tele-emergency care. Full article

Energy-transition policy increasingly asks households and small firms to behave as informed players in liberalised electricity markets. How far they can actually play that part, however, depends on two things at once: how energy-literate they are, and how clearly their bills speak to them. Although both strands are separately well researched, they are rarely measured jointly, on the same respondents, and at the level of the bill itself—the document through which almost every consumer actually meets the market. Working from a case study of Polish electricity customers, we examine how self-assessed knowledge of billing relates to perceived bill comprehensibility and to the detailed understanding of individual invoice elements. The evidence comes from a mixed-mode CATI/CAWI survey of 602 respondents—individual consumers, prosumers and micro/small enterprises—all served by a single major supplier in the Upper Silesia region. Because the achieved sample is dominated by older respondents of one supplier, the study is framed throughout as an exploratory, regional investigation. Three findings stand out. First, self-assessed energy literacy, perceived bill comprehensibility and the detailed understanding of individual invoice elements are positively interrelated (Spearman’s ρ between 0.49 and 0.61, p < 0.001), indicating that consumer competence and information design are complementary correlates of comprehension. Second, declared knowledge and understanding are socially patterned: they run higher among respondents aged 35–54 and those in a better financial position and lower among older and financially vulnerable customers, while a third of respondents find their current bill hard to understand. Third, Ward’s cluster analysis distinguishes three internally consistent layers of billing information—detailed billing parameters, transactional and payment content, and regulatory and legal content—of which the regulatory and legal layer is read least often. Because the data come from one supplier in one region, the findings are indicative rather than nationally representative and should be generalised only with care. The paper’s contribution is to measure energy literacy, perceived transparency and detailed bill comprehension jointly on the same respondents and to document—for a Central European retail market undergoing rapid price change—that the regulatory layer of the bill is precisely the layer consumers read least. For policy, the findings support piloting simpler bill structures, communication aimed at vulnerable groups, and energy education that equips consumers to take part in the market as the transition unfolds; given the sample, these implications are advanced as directions to be tested rather than as validated prescriptions. Full article

This study evaluates how digital transformation can reshape communication effectiveness in the context of cultural tourism through the restructuring of the technology value chain role. Through the support of technology, cultural values are reinforced and conveyed authentically and engagingly to enhance personal and social experiences, thereby improving communication effectiveness. Through multiple surveys with 393 participants, 380 responses were collected, ultimately yielding 368 valid responses in Da Nang, Vietnam, of which domestic tourists accounted for the majority at 54.6%, with the remainder being international tourists. Data analysis was performed using Microsoft Excel, SPSS, and AMOS, with hypotheses tested. The results show a positive but uneven impact of digital transformation on the quality of digital cultural content (greatest impact), digital engagement (second highest), and digital cultural experience. These results challenge some assumptions that role-playing experiences are the central strategy in creating digital value. It also shows that digital technology effectively supports the quality of media content while enhancing the inherent role of digital media in sharing, interaction, and personal immersion. Furthermore, perceived risks weaken the power of digital transformation on personal digital experiences but do not impact content quality. This result reflects the digital trust paradox, demonstrating both the effectiveness in increasing value for both customers and businesses, and the cautious attitude of tourists towards the potential risks from digital platforms. The distinct role of travel purpose in shaping travel behavior also reflects the contextual nature of the study. This research expands on implications beyond purely technology-accepting models by reflecting how technological infrastructure drives the creation of social value in terms of meaning and cultural tourism experiences. In practical terms, destination managers need to evaluate digital transformation as a strategic tool in creating human-centered content, fostering social–emotional connection and experiences to enhance sustainable destination communication effectiveness. Full article

Previous studies have shown that Bouldering Psychotherapy (BPT), an emerging integrative intervention combining bouldering with psychotherapeutic techniques, may promote improvements in mental health and well-being. This pilot study aimed to examine the effects of BPT on symptoms of depression and anxiety in a Brazilian population and explore participants’ perceptions of its psychological and social impacts. Eleven participants completed an eight-week BPT program and were compared with a matched control group. Symptoms of anxiety and depression were assessed before and after the intervention. Qualitative data were collected through semi-structured interviews and analyzed using word-frequency analysis and reflexive thematic analysis. The BPT group showed a significant reduction in depressive symptoms (p = 0.015, d = 0.66) and a marginally non-significant reduction in anxiety symptoms (p = 0.059, d = 0.44). The qualitative findings indicated perceived improvements in psychological well-being, emotional regulation, self-awareness, social connectedness, and psychological skills. Participants also reported transferring skills and insights acquired during the program to everyday life. Overall, the findings suggest that BPT may improve mental health, particularly depressive symptoms, while fostering supportive social relationships and positive psychological experiences. The results support the feasibility of adapting BPT to the Brazilian context and encourage further research on climbing-based psychotherapeutic interventions. Full article

Background: Problematic social media use among adolescents has emerged as a growing public health concern. This study examined gender differences in problems related to social media use and their behavioural, psychosocial, family-related, and school-related correlates among Finnish adolescents. Methods: In this cross-sectional study, binary logistic regression analyses were conducted using data from the Finnish sample of the 2024 European School Survey Project on Alcohol and Other Drugs (ESPAD), including 3293 adolescents aged 15–16 years. Results: Overall, 45% of girls and 30% of boys were classified as having problems related to social media use. Significant gender interactions were observed in the associations of gaming-related problems and perceived family socioeconomic status with problems related to social media use. Gaming-related problems were the strongest correlate, with a substantially stronger association among boys. Elevated psychological distress was associated with a higher likelihood of problems related to social media use, particularly among girls, whereas higher parental monitoring was associated with a lower likelihood only among girls. Truancy and plans for general upper secondary school were both associated with a higher likelihood of problems related to social media use among girls and boys. Conclusions: The findings suggest that problems related to social media use are closely linked to adolescent well-being and behaviour. Prevention and intervention efforts may therefore benefit from addressing problematic social media use as part of adolescent mental health and digital well-being strategies, combining universal approaches with targeted support for adolescents experiencing problematic patterns of digital media use. Full article

Background and Objectives: Rare diseases collectively affect large populations and require coordinated, patient- and caregiver-informed health and social support. This study had an overarching descriptive objective to characterize patient- and caregiver-reported experiences of living with rare diseases in Türkiye and a secondary exploratory objective to assess differences across broad disease categories. Materials and Methods: This cross-sectional, anonymous, voluntary non-probability online survey recruited affected individuals and relatives/caregivers through patient-organization networks. The 44-item questionnaire covered sociodemographic and caregiving context, diagnostic experiences, psychosocial support, healthcare access, and service-improvement priorities. Descriptive analyses, exploratory disease-group comparisons, Cramér’s V, and selected multivariable logistic regression models were used. Results: A total of 1642 responses were analyzed; 76.7% were completed by relatives/caregivers, and 66.4% concerned patients younger than 18 years. Among participants diagnosed after symptom onset (n = 1388), 34.4% reported an incorrect or alternative diagnosis and 64.0% sought at least one additional specialist opinion. Psychosocial support was needed by 74.2%, whereas 34.5% reported receiving professional support. Access to current treatment services was perceived as moderately adequate by 29.3% and adequate by 13.0%. The leading service-improvement priorities were increasing healthcare professionals’ knowledge (82.9%) and establishing specialized rare-disease centers (79.5%). Conclusions: This patient-organization-recruited survey provides a large descriptive account of the experiences and priorities reported by participating patients and caregivers. The findings identify perceived priorities, particularly clinician education and specialized centers, while not constituting nationally representative estimates. Full article

Informal learning spaces (ILS) in university teaching buildings support self-directed learning, collaboration, and social interaction. However, the correspondence between configurational visual accessibility and users’ perceived accessibility remains unclear. This study investigates informal learning spaces in two studio-based teaching buildings at Zhejiang University of Technology by integrating Space Syntax analysis and Post-Occupancy Evaluation (POE). A Configurational Visual Accessibility Index (CVAI), Perceived Accessibility Index (PAI), and Willingness to Stay (WTS) were used to examine relationships among spatial configuration, user perception, and behavioural intention. Quadrant analysis and regression models were employed to identify spatial mismatch patterns and examine the environmental factors associated with them. CVAI was not significantly associated with PAI, and approximately half of the investigated spaces exhibited mismatches between CVAI and subjective evaluations. Environmental qualities, particularly facility convenience and learning support, were significantly associated with perceived-accessibility and WTS mismatch patterns. Supplementary VGA analysis further showed that Isovist Compactness and Visual Clustering Coefficient provided additional explanation for part of these mismatches. The proposed CVAI–PAI–WTS framework establishes an integrated evaluation pathway linking spatial configuration, environmental support conditions, user perception, and behavioural intention. It provides a diagnostic approach for identifying mismatches between configurational potential and user experience, supporting the evaluation and optimisation of informal learning spaces. Full article

Technical intern trainees (TITs) preparing to depart for Japan study Japanese within a compressed four- to six-month pre-departure period, during which they must acquire language skills for workplace communication, daily life, and social adaptation. This cross-sectional study examined Japanese-learning challenges and technology use among Vietnam’s Japan-bound TITs, with working adults studying Japanese in Vietnam included as an unmatched descriptive benchmark rather than as a matched control group. Data were collected through an online self-administered questionnaire using snowball sampling. The study relied on self-reported data from 91 Vietnamese Japanese-language learners, including TITs (n = 44) enrolled in preparatory courses at training centers in Hanoi and working adults (n = 47) from diverse professional backgrounds. Overall, 57.1% of respondents reported high technology use, defined as using online tools for Japanese learning daily or multiple times daily. Smartphones were the dominant learning device, while YouTube, Mazii, ChatGPT, and social media were the most frequently used platforms. Technology was used mainly for vocabulary, listening, grammar, and Kanji learning. Major challenges included difficulty with Kanji, complex grammar structures, similar grammar patterns, unclear learning pathways, lack of correction or feedback, and distraction during self-study. Several learning-behavior variables showed associations with high technology use in unadjusted analyses, but these associations did not remain statistically significant after correction for multiple comparisons. Exploratory regression suggested a possible relationship between perceived effectiveness and high technology use, although the estimate was imprecise. The findings suggest that technology-supported Japanese learning for TITs may benefit from moving beyond scattered use of digital tools toward mobile-friendly, structured, feedback-rich learning pathways aligned with practical workplace and daily-life communication needs in Japan. Full article

Background: The prevalence of autism spectrum disorder (ASD) is increasing globally and in Saudi Arabia (SA), although many cases remain undiagnosed. Caregivers of children with ASD are confronted by challenges, especially mothers as primary caregivers, who have higher levels of stress and burden of care due to autism symptoms and difficulties of children, which negatively affects their quality of life (QoL). Objective: The primary outcome of this study was to assess primary caregivers’ quality of life and their perceptions of child-related difficulties associated with autism spectrum disorder (ASD) using the Quality of Life in Autism (QoLA) questionnaire. The secondary outcome was to examine the correlation between these two QoLA domains and identify the factors independently associated with each outcome Material and Methods: A convenience sample (247) of Saudi primary caregivers, primarily mothers, was taken from autism primary schools in Tabuk, Riyadh, Qassim, Hail, Jazan & Najran cities in SA by distributing an online questionnaire, which was composed of three parts, was used for data collection; Part I included demographic and clinical data of primary caregivers. Part II: The child’s personal characteristics. Part III: QoLA Questionnaire that measures the crucial aspects of living with autistic children and is composed of two parts (A and B). Data analysis was performed using the Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA), version 23. Results: More than half of the caregivers (50.2%) had a moderate level of QoL. Regarding caregivers’ perceptions of child-related difficulties, 70.9% reported high levels of difficulties, and 7.2% reported low difficulties. Quality of life was significantly associated with maternal age, educational level, number of children. The study’s univariate regression and multivariate regression analysis revealed that, QoL score had a significant negative association with maternal ages, university school and secondary school, working, and those who had medical diseases. In contrast, QoL level had a significant positive association with mothers who received training, had another person helped in caring for the child and who had enough income. Conclusions: Mothers of autistic children had poorer QOL and perceived more difficulties in caring for their children. Thus, educating sessions for mothers about dealing with their autistic children, psychological and financial support services are needed, which in turn improve their QoL. Full article

Forced migration is a global challenge, with displaced populations often remaining highly vulnerable because of pre-migration trauma, ongoing psychosocial stress, and structural barriers to integration. In response, locally grounded social innovations are increasingly used to address these issues. This article examines the implementation of the MindSpring program in Lithuania, serving as a novel local response to the integration of forced migrants. The analysis is based on a theoretical framework that highlights psychosocial vulnerability, trauma-informed care, and community-based support. It emphasizes a shift from individualistic integration models to approaches focused on collective empowerment, peer support, and active participation of migrant communities. MindSpring is presented as a peer-led psychosocial intervention that strengthens internal community resources and social cohesion. Empirical findings from qualitative interviews with Ukrainian refugees and trained community leaders indicate that participants reported perceived improvements in psycho-emotional well-being, including greater emotional stability, increased self-awareness, stronger relationships, and a deeper understanding of the host society. Community leaders also described increased self-confidence and the development of roles as mediators between migrant and host communities. We conclude that MindSpring can be understood as a contextually innovative form of social innovation within the Lithuanian context, providing opportunities for psychosocial reflection, peer connection, mutual support, and social participation. The findings may offer context-specific insights that could inform research or practice in other settings. Full article

Adolescents in international secondary schools develop their social lives across culturally diverse campuses and digitally connected peer networks. Although friendship quality, social media use, and adolescent well-being have each received substantial attention, the mechanisms through which offline and online social experiences jointly relate to social well-being remain conceptually fragmented. This structured conceptual review develops an integrated framework for international secondary school students in Malaysia. The framework is informed by the relatedness branch of Self-Determination Theory and the resource-exchange logic of Social Exchange Theory and proposes that peer relationship quality and meaningful social media use relate to social well-being via relatedness need satisfaction, perceived social support, and psychological resilience. Gender and cultural identity are conceptualised as contextual moderators rather than universal determinants. The review employs a transparent, purposive search and synthesis process, and differentiates the framework from previous reviews on friendship quality, social media use, or Self-Determination Theory as isolated constructs. This paper contributes by integrating offline and online social contexts, elucidating complementary motivational, resource and adaptive pathways, and situating these relationships within Malaysian international schools, where foreign curricula, English medium instruction, mixed nationalities, student mobility and cultural identity negotiation may shift the salience and strength of otherwise general adolescent mechanisms. The propositions are untested and are therefore offered as theoretically grounded expectations rather than empirical conclusions. The framework offers a focused agenda for longitudinal, multilevel, cross-cultural and intervention research and offers cautious guidance for school-based belonging, peer-support, resilience and digital citizenship initiatives. Full article

Background: Loneliness in older adults is a global public health problem. Although robust evidence exists regarding its consequences, the evidence base is marked by a bias towards high-income countries and urban contexts. The rural Peruvian Amazon is a territory virtually absent from the scientific literature on ageing and loneliness. Methods: We conducted a descriptive–interpretive qualitative study based on 34 semi-structured interviews with adults aged 60 years and over, recruited through Cáritas-Requena. Analysis followed the reflexive thematic analysis framework. Purposive sampling with maximum variation criteria was employed. The study was complemented by a quantitative characterisation using the Barthel Index, the LSNS-6 scale, and the DUKE-UNC-11 questionnaire. Results: Four themes emerged: (1) structural and functional conditions as the substrate of loneliness; (2) family reconfiguration driven by internal migration, with notable prominence of skipped-generation households (grandparents caring for grandchildren); (3) lived experiences of emotional and social loneliness, including a contextual pattern of feeling lonely despite the physical presence of others, which we descriptively label “paradoxical loneliness”; and (4) coping resources, including faith, work, neighbourhood networks, non-human companionship, and habituation. The descriptive relational measures showed different distributions: objective social isolation (LSNS-6 < 12) was observed in 12.5% of participants, whereas low perceived functional social support (DUKE-UNC-11 < 32) was observed in 68.8%; these measures assess distinct constructs and were used solely to contextualise the qualitative findings. Conclusions: Among the service-connected older adults included in this study, loneliness was shaped by the interaction of family reconfiguration, material and health-related conditions, and locally available coping resources. The experience of feeling lonely despite the physical presence of others was compatible with Perlman and Peplau’s cognitive discrepancy model and is presented here as a context-specific interpretive pattern rather than as an independent dimension of loneliness. Full article

Online spaces can be a source of suicide safety as well as suicide risk. What potentially restricts their safety value is the limited contemporary evidence regarding who engages online for suicide-related reasons. This study explored characteristic differences between individuals using social media/internet for suicide-related reasons (users) and those who do not (non-users). It sought to identify whether users differ in relation to psychological, interpersonal, and social characteristics compared to non-users. These characteristics were suicide risk (SBQ-R), depression symptomology (PHQ-9), social anxiety (SIAS), perceived social support (MSPSS), help-seeking intentions (GHSQ), mood states (BRUMS), social connectedness (SCS-R), and interpersonal needs (INQ). Ninety adults (Mage = 42.65, range 18–82 years) at elevated suicide risk (SBQ-R score ≥ 7) and recent experience of suicidal thoughts/behaviors completed an anonymous online survey. Users reported higher overall suicide risk, higher likelihood of disclosing suicidal thoughts, higher levels of depressive symptomology and social anxiety, and more frequent suicidal thoughts than non-users. There was no group difference in the likelihood of a future suicide attempt. Mood state differences indicated users reported higher scores for depression and confusion, with both groups reporting mood profiles associated with psychopathology risk. Across both groups, mood scores predicted 34.1% of the variance in overall suicide risk and 24.0% of the variance in likelihood of attempting suicide in the future. Given the relatively small sample size, the nonsupport of some hypotheses may be due to low power rather than no differences existing. However, the findings provide tentative support for the notion that suicide-related online use may help reduce the self-reported likelihood of future suicide attempts. Full article

Generative artificial intelligence has transformed AI chatbots into systems that can provide information, emotional feedback, and social interaction. Although prior research has examined AI adoption, trust, and continuance intention, less is known about sustained reliance on AI chatbots and its relationship with psychological adaptation. Drawing on an integrated compensation–resource framework, this study examined whether social anxiety was indirectly associated with psychological resilience through AI chatbot dependence and whether this association varied across levels of perceived social support. Cross-sectional survey data from 395 adult AI chatbot users recruited through an online survey platform in China were analyzed using regression-based path analysis and PROCESS Model 7. Social anxiety was positively associated with AI chatbot dependence and negatively associated with psychological resilience, while AI chatbot dependence was negatively associated with resilience after accounting for social anxiety. A small but statistically significant negative indirect association was observed through AI chatbot dependence. Higher perceived social support was associated with a weaker social anxiety–dependence association and a smaller negative indirect association. This buffering pattern was statistically significant but modest and weakened rather than eliminated the indirect association. These findings identify a context-specific pattern of statistical associations in human–AI interaction while underscoring the need for longitudinal research to establish temporal and causal direction. Full article

Whether agricultural cultural heritage (ACH) tourism supports sustainable heritage development depends partly on whether visits sustain the communication and internalization of heritage knowledge rather than merely produce favorable consumption evaluations. Drawing on experience economy theory, social identity theory, and tourism learning theory, this study constructs a mechanism model linking ACH experiences to tourists’ cultural learning. To reduce conceptual overlap, experience quality is defined as visitors’ perceived distinctiveness, novelty, and memorability of the visit, whereas perceived value is defined as a utilitarian assessment of gains relative to the money, time, and effort invested. ACH experience is therefore divided into three analytically distinct dimensions: experience quality, perceived value, and knowledge transfer. Cultural identity is introduced as a mediating variable and is understood as a layered psychological construct including cognitive recognition, affective attachment, and evaluative commitment. Income level is introduced as a moderating variable and is interpreted as a within-sample socioeconomic boundary condition after controlling for education and other demographic characteristics. In this study, sustainability is defined narrowly as the sociocultural continuity of ACH from the visitor side and is operationalized through perceived knowledge transfer, cultural identity, and self-reported cultural learning; income is used to examine whether this pathway differs across socioeconomic groups. Based on 430 valid questionnaires collected from visitors to ACH sites in Fujian Province, this cross-sectional study conducts empirical tests using structural equation modeling (SEM), Bootstrap mediation analysis, and hierarchical regression analysis. The results show that experience quality and knowledge transfer are positively associated with tourists’ cultural learning, with knowledge transfer showing the stronger association. Perceived value has no significant relationship with cultural learning, indicating that a consumption-level perception of value for money does not necessarily correspond to deeper cultural learning. Cultural identity fully mediates the statistical relationship between knowledge transfer and tourists’ cultural learning, revealing a dominant pathway linking knowledge transfer, cultural identity, and cultural learning. Income level positively moderates the relationship between cultural identity and tourists’ cultural learning. Because the data are cross-sectional and self-reported, these findings indicate theoretically consistent associations rather than definitive causal effects. The study contributes to sustainability research by offering a quantifiable visitor-side framework for monitoring knowledge communication, cultural connection, and learning-related outcomes. Repeated measurement of these indicators may support adaptive heritage management and inclusive cultural participation, but they should be combined with ecological, economic, and community-based indicators rather than treated as a complete sustainability index. Full article