Search Results (20,997)

Background: The widespread use of online review platforms has transformed how patients evaluate healthcare providers and has created a valuable source of patient-generated feedback on healthcare quality. Negative online reviews provide valuable insights into patient experiences and sources of dissatisfaction. This narrative review aimed to synthesize the main themes and concerns expressed in negative online patient reviews across healthcare and dentistry and to explore recurring patterns reported in the available literature. Methods: A narrative literature search was conducted between January 2015 and May 2026. Results: Twenty-two studies were included in the narrative synthesis. Negative online reviews reflected multiple dimensions of the patient experience, including interpersonal, communication, organizational, financial, and clinical concerns. Although the relative prominence of these themes varied across healthcare settings and specialties, dental studies more frequently emphasized treatment expectations, professional trust, and perceived value for money. Conclusions: The findings indicate that patient dissatisfaction expressed in negative online reviews is multidimensional and cannot be interpreted solely through clinical outcomes. Rather than establishing the relative importance of different determinants of patient satisfaction, this review characterizes the themes most commonly expressed in negative online reviews. As a complementary source of patient-generated insights, online reviews may inform patient-centered quality improvement initiatives and support improvements in healthcare service delivery. Full article

Urban competitiveness has traditionally been associated with infrastructure, economic performance, and innovation capacity, while the role of financial governance has received considerably less attention. This study examines how citizens form perceptions of urban financial integrity and whether such perceptions influence evaluations of urban attractiveness. Drawing on a governance-based framework, the study investigates the relationships among Digital Governance, Financial Transparency, Anti-Fraud Capacity, Financial Integrity, and Urban Attractiveness. Data were collected from 2764 residents of 18 digitally advanced cities across Northern and Western Europe and North America. To enhance methodological rigor, the sample was randomly divided into two equal subsamples and analyzed using Exploratory Factor Analysis, Confirmatory Factor Analysis, and Structural Equation Modeling. The results indicate that Digital Governance is positively associated with both Financial Transparency and Anti-Fraud Capacity, while Financial Transparency and Anti-Fraud Capacity are positively associated with stronger perceptions of Financial Integrity. Financial Integrity emerged as a significant predictor of Urban Attractiveness and served as the principal mechanism through which governance practices influenced broader evaluations of cities. The findings suggest that citizens do not perceive cities as attractive simply because they are digitally advanced; rather, digital governance becomes valuable when it enhances confidence that public financial resources are managed transparently, responsibly, and in the public interest. These results identify Financial Integrity as the key mechanism through which citizens translate governance quality into perceptions of urban attractiveness. Full article

Background/Objectives: Fibromyalgia (FM) is a chronic pain condition characterized by widespread pain, fatigue, sleep disturbances, and psychosocial challenges. Although physiotherapists play a key role in FM management, little is known about how biopsychosocial principles are applied in clinical practice. This study explored physiotherapists’ clinical reasoning, therapeutic strategies, and approaches to promoting adherence and functional recovery in FM. Methods: A qualitative study was conducted within a constructivist–interpretative paradigm. Thirteen physiotherapists with experience in FM management across different healthcare settings in Spain participated in semi-structured interviews. Participants were recruited through purposive and snowball sampling. Interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis following Braun and Clarke’s framework. Methodological rigor was ensured through reflexive engagement among researchers with differing backgrounds, reflexive practice, and adherence to COREQ guidelines. Results: Three overarching themes and seven sub-themes were identified. Clinical validation emerged as a key strategy to reduce uncertainty and facilitate engagement. Therapeutic goals were progressively shifted from pain reduction toward function, autonomy, and participation. Pain neuroscience education and individualized exercise were identified as the main therapeutic strategies, while group-based interventions promoted social support, motivation, and adherence. Lifestyle recommendations, including stable routines, social participation, and work adaptation, complemented treatment. Conclusions: Physiotherapists perceive FM management as a multidimensional process extending beyond symptom reduction. Validation, pain neuroscience education, individualized exercise, and group-based support appear to facilitate adherence, self-management, and functional recovery within a biopsychosocial framework. Full article

Background: Psychological well-being, meaning in life, social support, and daily activities are well-documented factors that significantly affect the psychological well-being of older adults. Nevertheless, research on the interactions among these variables and their collective impact on happiness is limited. The objective of this study was to examine the effects of meaning in life and social support on the overall happiness of older adults. Methods: A quantitative study employing a descriptive-analytic, cross-sectional design was conducted with 221 participants aged 65 and older who attended day-care centres in Pristina. The study used four validated instruments: the Pemberton Happiness Index (PHI), the Meaning in Life Questionnaire (MLQ), the Multidimensional Perceived Social Support Scale (MSPSS), and the Groningen Activity Restriction Scale (GARS). The statistical analyses included linear regression and interaction effects, with a significance level of p < 0.05. Results: Meaning in life (β = 0.614, p = 0.039) and social support (β = 7.695, p = 0.012) were significant positive predictors of happiness. GARS was not shown to have a direct main effect but emerged as a significant moderating factor. Interaction effects of MLQ × GARS (p = 0.037) and MSPSS × GARS (p < 0.001) showed that functional limitations strengthen the positive impact of meaning in life and social support on subjective well-being. Conclusions: Meaning in life and social support are important psychosocial determinants of well-being among older adults, particularly in the presence of functional limitations. The findings highlight the importance of integrated, person-centred approaches within community and healthcare services that address psychosocial well-being alongside functional capacity. Routine assessment of psychosocial and functional needs may support more effective interventions aimed at improving quality of life and healthy ageing among older adults. Full article

Background and aims: Adolescent mental health is a core component of Goal 3 “Good Health and Well-being” in the SDGs. This study explores the relationship between academic burden and adolescent mental health under China’s “Double Reduction” policy, as well as the roles of perceived stress and self-efficacy in this relationship. Method: Using the purposive sampling method, 842 samples of junior high school students in Nantong City, Jiangsu Province, China, were effectively collected. Statistical analyses included a common method bias test, correlation analysis, multiple linear regression and the Bootstrap method. Results: Studies have shown that under the “Double Reduction” policy, there are pairwise correlations between academic burden, perceived stress, self-efficacy and adolescent mental health. After controlling for sociodemographic characteristic covariates, academic burden remained significantly negatively correlated with adolescent mental health (β = −0.277, p < 0.001), and the negative correlation degree between in-school academic burden and mental health (β = −0.295, p < 0.001) was greater than that of out-of-school academic burden (β = −0.070, p < 0.05). Furthermore, perceived stress and self-efficacy exhibited a composite correlational linkage pattern within this relationship—simultaneously encompassing both parallel and serial multiple associative pathways. Conclusion: Under the “Double Reduction” policy, academic burden and Chinese adolescents’ mental health show a significant negative association, with perceived stress and self-efficacy acting as key bridges. Full article

The compensation a farmer requires to reduce fertilizer use reflects the behavioral factors behind the decision to participate. This study examines how they are associated with compensation expectations, and whether these associations differ across operator types, by integrating the Theory of Planned Behavior with a discrete choice experiment. Using survey data from 1066 rice farmers in Jiangsu Province, China, we recover each farmer’s willingness-to-accept (WTA) for fertilizer reduction as a money-metric proxy for the intention to participate, and model it as a function of behavioral attitude, social-institutional norm, and perceived behavioral control separately for conventional smallholders, specialized large-scale planters, and registered family farms. The pattern of associations differs across operator types. A favorable attitude is associated with a lower WTA only among smallholders, the social-institutional norm among smallholders and family farms, and perceived behavioral control among large-scale planters and family farms; the evidence for the attitude association among smallholders and for the norm association among family farms is relatively weaker. Each construct is thus associated with compensation expectations in a distinct subset of operator types, a structure that pooled estimation obscures. The findings suggest that differentiated policy could match attitudinal, capability-building, or institutional levers to the channel associated with each operator type, rather than relying on uniform payment increases. Full article

The construction sector has a significant impact on natural resources consumption and waste generation. In accordance with circular economy principles, the adoption of secondary materials, encompassing both reused and recycled components, by construction companies is of increasing strategic importance, especially in cities and their surrounding areas. However, enterprises in this sector continue to face substantial challenges related to implementation of these materials. The article aims to investigate the opinions of representatives of companies operating in the construction sector in the West Pomeranian Voivodeship of Poland regarding the benefits and obstacles associated with the implementation of secondary materials, as well as to identify measures that could contribute to the wider use of these materials in practice. The study was conducted using a diagnostic survey method based on computer-assisted web interviews. The sample comprised 46 respondents from the West Pomeranian Voivodeship of Poland. The analysis of the collected opinions emphasized that waste reduction, protection of the environment and natural resources are perceived as the most significant benefits. Among the main obstacles to implement these materials, respondents highlighted the lack of specialized platforms for secondary materials trading, difficulties in materials sorting, including construction and demolition waste, as well as complex bureaucratic procedures. In the respondents’ opinion, the measures crucial for facilitating the use of secondary materials include the development of legislation enabling the reclassification of waste as secondary construction materials, ensuring reliable access to these materials, and providing government support. It was revealed that despite broad recognition of environmental benefits, the primary obstacle is the absence of an effective marketplace for secondary materials, pointing to a crucial role for institutional intervention. Recommendations for companies’ managers from the construction sector, designers and local policymakers were proposed. Full article

Background: Empathy is essential for supportive nursing work environments, yet little is known about Generation Z (Gen Z) nurses’ experiences of empathy from colleagues and nurse managers. Aim: To examine Gen Z nurses’ experiences of empathy in workplace relationships with colleagues and nurse managers and the individual, generational, and institutional factors shaping these experiences. Methods: A qualitative descriptive study design was employed. Data were collected between October 2025 and March 2026 through semi-structured, in-depth interviews with 20 Gen Z nurses working in diverse clinical settings in Turkey. Participants were recruited using purposive and snowball sampling. Interviews were conducted via Zoom, audio-recorded with consent, and transcribed verbatim. Data were analyzed using Braun and Clarke’s reflexive thematic analysis framework. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist guided the study reporting. Results: Four main themes were identified: (1) perceptions of empathy among Gen Z nurses, (2) empathy experiences in workplace relationships, (3) factors influencing empathy experiences, and (4) expectations for building an empathic work environment. Empathy was experienced through feeling understood, non-judgmental listening, and emotional and practical support, particularly in peer relationships. Hierarchical communication, perceived intergenerational differences, workload, and time pressure were key factors influencing workplace empathy experiences. Conclusions: Participants described empathy as a relational and context-dependent experience embedded in everyday workplace interactions. Their accounts suggest that supportive, non-hierarchical relationships may facilitate empathic engagement, whereas rigid communication styles and heavy workloads may act as barriers. These findings represent the experiences and interpretations of the Gen Z nurses interviewed and should not be read as objective comparisons between generations. Organizational strategies that support empathic communication and psychologically safe teamwork may help strengthen team cohesion and nurse retention. Full article

Background/Objectives: Postpartum hemorrhage (PPH) remains a major obstetric emergency requiring rapid clinical decision-making, timely intervention, and effective teamwork. Healthcare providers’ self-efficacy is an important factor in perceived confidence and preparedness for managing PPH. This study aimed to determine the PPH-specific individual and collective self-efficacy levels of obstetric healthcare providers working in a tertiary care hospital and to examine associated sociodemographic and professional factors. Methods: This analytical and cross-sectional study was conducted among 149 physicians, midwives, and nurses working in obstetrics and gynecology units between 2 and 30 March 2026. Data were collected using a Personal Information Form and the Postpartum Hemorrhage-Specific Self-Efficacy Scale (PHSSES). Descriptive statistics, Mann–Whitney U test, Kruskal–Wallis test, and Spearman correlation analysis were used. Results: The mean PHSSES total score was 6.69 ± 0.81, while the mean individual self-efficacy and collective efficacy subscale scores were 6.34 ± 1.00 and 6.90 ± 0.88, respectively. PHSSES total scores differed significantly according to obstetric clinical experience (p < 0.05). The self-efficacy subscale was associated with several professional and clinical characteristics, including profession, working unit, obstetric clinical experience, PPH exposure, and previous PPH training (p < 0.05). Weekly working hours were positively correlated with PHSSES total and both subscale scores (p < 0.05). The most frequently reported PPH interventions were manual uterine massage and uterotonic drug administration. Conclusions: Obstetric healthcare providers demonstrated high PPH-specific self-efficacy, with collective efficacy exceeding individual self-efficacy. Individual self-efficacy was associated with professional and clinical characteristics, including PPH experience and previous training. The findings may inform targeted interdisciplinary training strategies for PPH management. Full article

This study examines how supportive university environment (SUE), faculty competence (COMP), employability skills development (ESD), and financial confidence (FC) shape pre-service teachers’ (PSTs) financial well-being (FWB) and perceived university academic reputation (REP). Drawing on social cognitive theory, human capital logic, and signaling perspectives, this study develops and tests a PLS-SEM model using survey data from 1225 pre-service teachers in Egypt and Kuwait, with ESD and FC operating as key mechanisms linking institutional and instructional factors to student and reputation-related outcomes. The findings show that SUE positively predicts FC and ESD, while COMP enhances ESD. ESD, in turn, positively influences FC, FWB, and REP, and FC further improves FWB. Mediation analysis indicates that ESD and FC explain the indirect effects of SUE and COMP on FWB, while ESD mediates their effects on REP. Cross-country analysis suggests that the model is broadly stable across Egypt and Kuwait. The findings suggest that teacher education institutions should integrate employability-oriented learning, financial confidence-building activities, and faculty-supported career preparation to enhance PSTs’ financial well-being and strengthen perceived academic reputation. Full article

Cancer survivors face an elevated risk of severe COVID-19 outcomes and were prioritized for vaccination, yet reported rates of vaccination refusal in this population vary widely. The objective of this scoping review was to map the available evidence on COVID-19 vaccination refusal among adult cancer survivors in the United States, to characterize the reported barriers and enablers, and to examine how differences in measurement account for variation in the reported estimates. PubMed, EBSCOhost, CINAHL, medRxiv, and Google Scholar were searched for studies published between 1 December 2020 and 30 April 2026 reporting primary data on COVID-19 vaccination refusal among U.S. adults with a current or previous cancer diagnosis. Findings were charted and summarized descriptively. Six sources comprising 3344 participants met the eligibility criteria. Reported refusal ranged from 7.3% to 39.0%, a more than fivefold difference, with a median of 14.7%. This variation corresponded closely to what each source measured: declination of an offered vaccine, likelihood of acceptance on a Likert scale, hesitancy assessed before vaccines were widely available, or observed non-receipt of any dose. Barriers included concerns about vaccine safety, efficacy, and interaction with cancer treatment, mistrust of science and government, and low perceived need; clinician recommendation was the most consistent enabler. Estimates of vaccination refusal in this population are not directly comparable and should be interpreted alongside the construct measured. Full article

Background/Objectives: Cardiovascular diseases are the leading cause of morbidity and mortality in older adults and are frequently associated with multidimensional frailty and reduced quality of life. The present study aimed to investigate the associations among multiple domains of the Comprehensive Geriatric Assessment (CGA), including frailty, cognitive status, emotional status, nutritional status, functional status, fall risk, psychological resilience, and perceived quality of life, in older adults with cardiovascular disease. Methods: A cross-sectional observational study was conducted on 100 patients aged ≥60 years admitted to the Geriatrics Department of the “Dr. C.I. Parhon” Clinical Hospital, Iași. Cognitive, emotional, nutritional, and functional status, fall risk, frailty (Fried and Tilburg scales), resilience- Connor–Davidson Resilience Scale-25 (CD-RISC-25), and quality of life- World Health Organization Quality of Life–BREF (WHOQOL-BREF) were assessed. Statistical analysis included chi-square or Fisher’s exact tests and exploratory discrimination analysis using ROC curves. Results: Overall, 61% of participants reported a very good quality of life, whereas the remaining 39% reported a moderately reduced quality of life. Better perceived quality of life was significantly associated with preserved cognitive status, fewer depressive symptoms, better nutritional status, lower frailty (as assessed by both the Fried Frailty Phenotype and the Tilburg Frailty Indicator), preserved functional independence, lower fall risk, and greater psychological resilience (all p < 0.05). In contrast, neither demographic characteristics nor cardiovascular diagnoses were significantly associated with quality of life. Exploratory receiver operating characteristic (ROC) analysis demonstrated modest discriminatory performance for cognitive status— Mini-Mental State Examination (MMSE) (AUC = 0.660; p = 0.007), nutritional status— Mini Nutritional Assessment (MNA) (AUC = 0.624; p = 0.038), and the Tilburg Frailty Indicator (AUC = 0.635; p = 0.024), whereas psychological resilience exhibited an inverse relationship with the predefined outcome (AUC = 0.293; p = 0.001). Conclusions: In hospitalized older adults with cardiovascular disease, perceived quality of life was primarily associated with multidimensional geriatric, functional, nutritional, cognitive, and psychosocial factors, rather than with demographic characteristics or cardiovascular diagnoses. Psychological resilience was identified as an important psychosocial correlate of better perceived quality of life, supporting its inclusion in individualized comprehensive geriatric interventions. These findings highlight the importance of comprehensive geriatric assessment in identifying factors associated with quality of life. Given the cross-sectional design, the observed relationships should be interpreted as associations rather than causal effects and require confirmation in prospective longitudinal studies. Full article

Representations of engineering work in the curriculum influence students’ perceptions of valued skills and knowledge in the field. Industrial engineering attracts a diverse group of students and is well positioned to incorporate longstanding calls for comprehensive skills because of its systems-level approach to problem-solving. Examining students’ perceptions of the curriculum of industrial engineering can elucidate how the curriculum shapes diverse students’ understandings of engineering practice and their decisions to persist or leave. Using Holland’s framework of figured worlds, we examined the role of the core industrial engineering curriculum at a Midwestern university (MU) in the United States (U.S.) in shaping undergraduate students’ perceptions of valued skills and knowledge and sense of fit in engineering. Findings from a series of two interviews with 15 upper and lower division industrial engineering students indicate that students perceived the core curriculum at MU to minimally emphasize comprehensive skills, reinforcing a purely technical view of engineering. Further, students expressed a desire for course content that emphasized application of theoretical concepts and social and cultural context and impact. Findings indicate a continuing need for curricular reform incorporating comprehensive skills to engage students, align coursework with real-world engineering practice, and shape the perception of engineering work as inherently sociotechnical. Full article

Generative artificial intelligence is increasingly used to produce user interface designs, yet the usability and task-performance implications of AI-generated interfaces remain insufficiently quantified. This study proposes a reproducible evaluation framework combining computational visual complexity metrics with human-centered interface assessment. Twelve user interfaces were evaluated across four scenarios: a mobile health dashboard, a learning management system dashboard, an e-commerce shopping cart, and a university student information portal. Each scenario included three design conditions: human-designed reference interfaces, raw AI-generated interfaces, and prompt-optimized AI-generated interfaces. Computational metrics included grayscale Shannon entropy, spatial edge density, RGB color entropy, RMS contrast, robust contrast, and white-space ratio. A within-subject user study with 62 participants measured perceived cognitive load, perceived visual complexity, task ease, interface evaluation time, and task accuracy. Friedman tests revealed significant differences among the interface conditions for all five user-centered outcomes, with very large effect sizes. Raw AI-generated interfaces were associated with the highest perceived cognitive load, highest perceived visual complexity, lowest task ease, and longest interface evaluation times. Within the tested stimulus set, prompt-optimized AI-generated interfaces showed more favorable user-centered outcomes than raw AI interfaces but remained statistically distinct from human-designed references in perceived cognitive load, perceived visual complexity, task ease, and interface evaluation time. Task accuracy reached 100% for both human-designed and prompt-optimized AI interfaces, whereas raw AI interfaces achieved 63.10%. Interface-level correlations between computational visual metrics and user outcomes were weak to moderate, suggesting that pixel-level visual complexity measures capture only part of the perceived usability burden. Overall, these findings support the potential value of prompt-based HCI constraints in AI-generated interface design, while robust evaluation should integrate computational metrics with human-centered testing. Full article

Environmental sustainability projects are essential for preserving natural resources and enhancing quality of life for present and future generations. This cross-sectional study examined Saudi residents’ knowledge and awareness of green projects, attitudes and perceptions toward them, personal environmental behavior and participation, and perceptions of institutional and societal roles. A questionnaire was administered to 1044 participants from various regions across Saudi Arabia. Descriptive statistics, including means and standard deviations, together with the Mann–Whitney U test, Kruskal–Wallis H test, and Dunn’s post hoc test, were used to answer the research questions and test the hypotheses. The findings indicated generally positive responses across the four dimensions; at the item level, most items fell within the agree range, while neutral ratings appeared mainly in items related to following green-project news, reviewing related policies, using low-emission transportation, and the perceived sufficiency of institutional communication. Significant differences were observed in the overall questionnaire and several dimensions according to gender, favoring females, and according to nationality, favoring Saudi participants. Regional differences were limited to the environmental behavior and personal participation dimension, whereas educational qualification did not produce significant differences. The absence of educational differences suggests that green-project awareness and behavior may be shaped not only by formal educational level, but also by national campaigns, media exposure, and shared public discourse. The study provides a countrywide empirical baseline for green-project awareness, attitudes, and environmental behaviors in Saudi Arabia and identifies areas for more targeted communication, regional engagement, and longitudinal research. Full article