Search Results (312)

Exercise plays a key role in managing type 1 diabetes mellitus (T1DM), and virtual reality (VR)-based exercise offers an innovative solution to increase motivation and deliver meaningful health benefits to patients who are often hesitant to engage in physical activity. The purpose of this study was to assess the acceptability, usability, intention for future use, and preference of a VR-based cycling application, as well as to investigate the effects of VR-based exercise on the physiological, biochemical, and psychological parameters of individuals with T1DM compared to conventional exercise. This study represents a preliminary investigation with a small sample size of 11 patients with T1DM. Each participant underwent two 20 min low-intensity exercise trials. One session involved conventional cycling on a stationary ergometer, while the other used a VR-based cycling application. The two exercise conditions were conducted 48 h apart, without a formal washout period. According to the results, high scores were observed for preference, acceptance, and usability of the VR-based cycling application, and statistically significant improvements in mood and enjoyment were observed following the VR-based cycling compared to conventional cycling. Additionally, while no statistically significant differences were found in physiological parameters (blood glucose, blood pressure, and heart rate) between the two conditions, the VR-based session showed a trend toward greater reductions. In conclusion, the use of VR technology in the field of cycling exercise has great significance in improving the mood and engagement of T1DM patients in exercise programs, providing a user-friendly and well-accepted VR cycling application; subsequently, it has also shown preliminary potential for the regulation of biological parameters. Healthcare professionals could easily expand exercise protocols with the strengths of the VR technologies along with other health-related programs. Full article

Suicide in children is a major global health crisis, with profound impacts on families, friends, and society. Understanding ways to ameliorate the rate of suicide attempt (SA) is critical given that it is a key factor in predicting future suicide risk. SA is the deliberate act of causing physical injury to oneself with the intent of death. The incidence of SA may be influenced by physical activity (PA). PA includes bodily movement via skeletal muscles that results in energy expenditure and physical fitness. While there is evidence to suggest that PA improves dysregulation of the parasympathetic nervous system which underpins the physiology of suicidal behaviour, evaluating the impact of PA on SA in children is required. Objectives: This systematic review aims to determine the relationship between PA and SA in children to inform alternative preventative and interventional strategies. Methods: This systematic review was registered with PROSPERO: CRD42023389415. Eight electronic databases were systematically searched. References were transferred to Covidence software for title and abstract screening and full text review were performed based on eligibility criteria: (1) children aged 6–18 years old; (2) participated in PA (individual, group exercise, or team sports); and (3) examined SA as a dependent variable. The JBI Checklist was used to measure the quality and level of bias of included studies. Results: Of the 2322 studies identified, 21 were included in the final analysis of the review. Twenty studies were cross-sectional in design, and one implemented a prospective study design. Thirteen studies (61.9%) yielded statistically significant results, indicating that increased PA, particularly team sport, may be associated with reduced odds of SA. There was some evidence to suggest that certain intensities and frequencies of PA may be beneficial to some and detrimental to other subgroups. Conclusions: The results suggest that PA may reduce the risk of suicide attempts. Although PA may be associated with reduced SA in children, future research is required, which (1) uses standardised outcome variables; (2) adopts longitudinal and experimental study designs; (3) explores qualitative research to determine distinctive factors that influence participation in PA not captured by quantitative research; and (4) examines different target populations such as children with a broad range of mental health issues. Full article

In response to growing concerns about overtourism and the need for sustainable heritage tourism, this study investigates how external environmental stimuli affect tourists’ perceived value and behavioral intentions in historic urban environments. Using the Stimulus–Organism–Response (SOR) model as the theoretical framework, and based on 275 valid questionnaires collected from five major sites in the Historic Center of Macau, this study explores the direct and indirect relationships among four types of environmental stimuli (physical factors, social activities, environmental atmosphere, and information and services), perceived value, and behavioral intentions. The results of structural equation modeling (SEM) indicate that all four stimuli significantly influence perceived value and behavioral intentions. Among them, physical factors exert the strongest influence on perceived value (β = 0.291, p < 0.001), while social activities are the most influential predictor of behavioral intentions (β = 0.225, p < 0.01). Perceived value plays a significant mediating role in all relationships, with the largest mediation effect found in the path from physical factors to behavioral intentions (27.99%), followed by environmental atmosphere (24.80%), information and services (22.62%), and social activities (11.66%). These findings validate the applicability of the SOR model in heritage tourism contexts and highlight the central role of perceived value in shaping tourist behavior. Theoretically, this study advances our understanding of how multidimensional environmental stimuli contribute to value-based decision-making in tourism. Practically, it provides actionable insights for urban planners and heritage managers to design environments that promote deeper engagement and foster sustainable tourist behavior in high-density historic destinations like Macau. Full article

Although the benefits of regular physical activity are widely recognized, many university students fail to sustain consistent exercise behaviors. This phenomenon may be attributed to cognitive and motivational barriers, particularly perceptions of goal attainability and attribution styles, which are believed to significantly influence students’ health beliefs and intentions to engage in physical activity. This research aimed to examine the independent and combined effects of goal attainability and attribution style on Chinese university students’ health beliefs and willingness to exercise. The study also investigated how shifts in attribution style may influence these outcomes under different levels of goal attainability. Two between-subjects experiments were conducted. In Experiment 1 (N = 146), a 2 (goal attainability: high vs. low) × 2 (attribution style: internal vs. external) design was used. Participants were exposed to tailored exercise advertisements and completed standardized questionnaires measuring health beliefs and exercise intentions. Experiment 2 (N = 130) adopted a 2 (goal attainability: high vs. low) × 2 (attributional shift: external-to-internal vs. internal-to-external) design, utilizing visual priming and short video interventions to manipulate attributional orientation. In Experiment 1, both high goal attainability and internal attribution independently enhanced participants’ health beliefs and exercise willingness. A significant interaction effect was observed only for exercise willingness, with the highest intentions found in the high attainability × internal attribution group. In Experiment 2, shifting attribution from external to internal significantly increased both health beliefs and exercise willingness, while shifting from internal to external resulted in substantial decreases. An interaction effect was again found only for exercise willingness, suggesting that the effectiveness of attributional shift depended on goal attainability. By integrating the Health Belief Model with Attribution Theory, this study offers a deeper understanding of how cognitive and motivational factors influence exercise behavior, and provides a theoretical foundation for developing adaptive interventions. Full article

Background/Objectives: The workplace represents an ideal context for applying policies to foster a healthy lifestyle, guaranteeing advantages both to the individual and the company. Nevertheless, motivation to change one’s lifestyle remains an issue. This study aimed to determine subjects’ most valued intentions toward lifestyle changes and the target actions to improve lifestyles that they would be willing to invest in economically, information which might help design effective intervention programs. Methods: Classification trees were applied to 2762 employees/ex-employees (55.09 ± 13.80 years; 1107 females and 1655 males) of several Italian companies who voluntarily filled out an anonymous questionnaire on lifestyles (inquiring about, e.g., exercise, nutrition, smoking, and stress) to unveil specific subject typologies that are more likely associated with, e.g., manifesting a specific intention toward lifestyle changes and choosing the two most popular target actions resulting from the survey. Results: The main lifestyle aspect that respondents desired to improve was to become more physically active, and the most preferred tools chosen to improve their lifestyle were the possibility of having a medical specialist consultant to prescribe a tailored lifestyle program and buying a gym/swimming pool membership. Conclusions: This observational study might help tailor worksite health promotion and insurance services offered to employees, initiatives that may play an important role in fostering health/well-being and preventing chronic diseases in the more general population, especially in healthy or young subjects who are more prone to change their behavior if immediate benefits are seen instead of only advantages in the future. Full article

Background: This study examines how social and geographical factors shape life satisfaction among older adults in South Korea, which became a super-aged society in 2024. As Korea moves toward implementing a nationwide integrated eldercare system by 2026, understanding the contextual determinants of wellbeing among older populations is critical for effective policy design. Methods: We use nationally representative survey data and apply a two-stage instrumental variable regression approach to address potential endogeneity in estimating the effects of key predictors on life satisfaction. Results: Subjective health and social connectedness are positively associated with life satisfaction. Physical activity shows context-specific effects, with notable differences between urban and rural areas. Surprisingly, greater accessibility to government services is linked to lower levels of physical activity, indicating a possible unintended consequence of well-intentioned policy measures. Gender differences are also evident: in urban areas, women report higher life satisfaction than men, whereas in rural areas, men report higher satisfaction than women. Conclusions: These findings highlight the need for aging policies that are context-sensitive and socially inclusive. Policymakers should consider regional and gender-specific dynamics when designing programs to improve life satisfaction among older adults in a rapidly aging society. Full article

Background: This project focuses on the relevance of using a health literacy approach to educating children about obesity prevention. The Habits of Health and Habits of Mind© model was used to write Electronic Texts for Health Literacy© to encourage actions that support obesity prevention. Guided by the Integrative Theory of Behavioral Prediction, the design template for a new genre of digital texts called Electronic Texts for Health Literacy© emerges for exploring children’s frame of mind, health literacy skills, and behavioral intentions toward obesity prevention. Methods: Online materials from selected websites were strategically reviewed for improving obesity prevention and child health literacy. The digital resources were juxtaposed with the Electronic Texts for Health Literacy©, with the latter written by and for children. Discussion: Health educators who use a constructivist pedagogy can help students to write health literacy narratives about obesity prevention, then read and talk about their multimodal compositions to further the practice and development of their health literacy skills. Children with obesogenic body frames can also gain from cowriting visual–textual–gestural health narratives with their peers or health professionals. Co-constructed narratives can help children make deeper connections about their identity, frame of mind, and social agency. Summary: Although this untested resource is available as a new genre of digital text, health educators could nudge children toward developing a stronger frame of mind and behavioral intentions toward obesity prevention when they write health literacy narratives that focus on decision making, goal setting, and communication in the context of eating nutritious foods and participating in physical activities. Full article

Background: External social influences on body image affect females differently than males, and adolescent girls are more likely to want to change their weight status. Understanding the healthy and unhealthy habits of adolescent girls is vital for developing effective and targeted health promotions and interventions. Methods: Using data from the 2021 Youth Risk Behavior Surveillance System (YRBS) survey, this cross-sectional study compares dietary habits, physical activity, vaping, alcohol use, sleep, and screen time in females (9th–12th grades) who intend to lose weight versus those who want to maintain their current weight. Results: The sample consisted of 4362 females, of which 56.7% reported an intent to lose weight. The average BMI percentile was 64.1 compared to 75.4 among those trying to lose weight and 50.1 among those not trying to lose weight. Adolescent girls intending to lose weight also reported less frequent breakfast consumption (OR 0.52; 0.40–0.69), less sleep (OR 0.72; 0.59–0.89), more screen time (OR 1.27; 1.02–1.58), engaging in muscle toning exercises (OR 1.30; 1.07–1.57), vaping (OR 1.22; 1.01–1.47), and alcohol use (OR 1.61; 1.32–1.98) compared to those not intending to lose weight. Conclusions: Adolescent girls trying to lose weight would likely benefit from interventions to help them improve sleep, reduce screen time, improve dietary and exercise habits, and monitor alcohol and vaping use. Full article

People act in ways that align with the values and roles that constitute their identity. However, the consistency of identity’s influence across different behaviours, and whether identity influences behaviours directly or indirectly via intention, self-determined motivation, or habit, remains uncertain. Participants (N = 98; Mage = 30.4 years, SD = 11.7 years) completed up to 12 weekly surveys, self-reporting engagement in physical activity, student, and support-seeking behaviours, and behaviour-associated identity, intention strength, self-determined motivation, and habit. Stepwise multilevel models tested the between- and within-person associations of identity with behaviour, and whether the relationships remained after accounting for intention, self-determined motivation, and habit. Results suggested identity as stable, with the most variability at the between-person level. Identity was associated with behaviour at both within- and between-person levels, with the exception that support seeking and identity were only associated between-person. For student behaviour and physical activity, the identity–behaviour relationship at the within-person level waned and became non-significant after accounting for intention, but not self-determined motivation or habit. These findings highlight that identity may be difficult to change. However, as identity is associated with a range of behaviours, a person’s identification with a particular behaviour may be valuable for tailoring behaviour change interventions, specifically through or in the same way as behavioural intentions. Full article

Despite the rapid advancements in payment technologies, cash continues to play a significant role in modern society. This phenomenon presents a unique area of analysis, particularly within metropolitan societies such as those in the Jakarta metropolitan area in Indonesia. The present study aimed to investigate cash usage in the Jakarta metropolitan area by analyzing two cases: (1) cash usage in physical stores, and (2) intention to continue to use cash in daily activities. To this end, two analytical techniques were employed: logistic regression and structural equation modeling (PLS-SEM). These techniques were implemented using data from 400 respondents residing in the Jakarta metropolitan area. The results of the study indicate a preference for cash over digital payments in transactions among a significant proportion of the respondents. The determinant analysis further identified several factors influencing cash usage in physical stores, including education, employment status, and the number of bank accounts. Furthermore, this study identified attitudes toward behavior, subjective norms, and satisfaction as variables affecting the intention to continue using cash in Indonesian society. Full article

Background/Objectives: Glycemic control is essential for preventing both short- and long-term complications of type 2 diabetes (T2D), requiring strict adherence to pharmacological therapy. Medication adherence directly influences therapeutic effectiveness, making its assessment in clinical practice crucial. This study aimed to evaluate medication adherence in elderly patients with T2D and its association with glycemic control. Methods: A descriptive cross-sectional study was conducted in the Algarve, Portugal, involving 133 elderly patients (≥60 years) with T2D. Cardiometabolic parameters and medication adherence (global, intentional, and unintentional) were assessed. Statistical analyses were performed using IBM SPSS Statistics 28.0. Results: The study population had a mean age of 71.7 ± 5.7 years, with a predominance of male participants (57.9%) and a high prevalence of dyslipidemia and/or hypertension. Cardiometabolic control was generally poor, with only 26.3% achieving blood pressure targets (≤140/90 mmHg), 8.5% maintaining fasting glycemia within the recommended range (70–110 mg/dL), and 13.6% attaining glycated hemoglobin (HbA1c) values ≤ 7%. Despite this, medication adherence was notably high (97.7%), with no significant association with cardiometabolic control (p > 0.05). Unintentional non-adherence behaviors, such as forgetfulness and inconsistent medication schedules, were the most frequently reported. Conclusions: Although elderly patients with T2D demonstrated high medication adherence rates, their cardiometabolic control remained suboptimal. Unintentional non-adherence behaviors may contribute to poor glycemic control. However, medication adherence alone does not fully explain these outcomes, highlighting the need to assess adherence to other self-care behaviors, particularly dietary and physical activity patterns. Future interventions should integrate comprehensive lifestyle modifications alongside pharmacological management to enhance overall disease control. Full article

Background/Objectives: Motivation is a key factor for improving motor function and cognitive control in patients. Motivation for rehabilitation is influenced by the relationship between the therapist and patient, wherein appropriate voice encouragement is necessary to increase motivation. Therefore, we examined the differences between mothers and other individuals, such as physical therapists (PTs), in their verbal interactions with children with cerebral palsy who have poor communication abilities, as well as the neurological and physiological effects of variations in the tone of their speech. Methods: The three participants were children with cerebral palsy (Participant A: boy, 3 years; Participant B: girl, 7 years; Participant C: girl, 9 years). Participants’ mothers and the assigned PTs were asked to speak under three conditions. During this, the brain activity of the participants was measured using a 19-channel electroencephalogram. The results were further analyzed using Independent Component Analysis frequency analysis with exact Low-Resolution Brain Electromagnetic Tomography, allowing for the identification and visualization of neural activity in three-dimensional brain functional networks. Results: The results of the ICA frequency analysis for each participant revealed distinct patterns of brain activity in response to verbal encouragement from the mother and PT, with differences observed across the theta, alpha, and beta frequency bands. Conclusions: Our study suggests that the children were attentive to their mothers’ inquiries and focused on their internal experiences. Furthermore, it was indicated that when addressed by the PT, the participants found it easier to grasp the meanings and intentions of the words. Full article

Outdoor education camps offer adventure programs to schools that deliver camp-based activities that challenge students in various ways. These camps provide students with an opportunity to learn in a natural environment, interact with their peers outside of the classroom, and participate in activities that challenge them both physically and mentally. Youth Adventure Camps also espouse a Christian ethos, Christian values, and spirituality, which are also key focuses. Prior research into outdoor education camps has examined the social, emotional, and physical benefits for students. In this study, data were collected through semi-structured interviews with five (n = 5) Christian Youth Adventure Camp (CYAC) staff to better understand their experiences and perceptions of their induction, ongoing training, strategies, and pedagogical approaches used to deliver the CYAC camp programs. Targeted observations of camp staff (N = 5) in action were also used to identify the intentional pedagogies they used to embed CYAC’s philosophy within their camp programs. This paper is part of a larger study, and its findings are focused on the perspectives of the camp leaders for two key reasons: First, we wanted to examine the intentional pedagogies of camp leaders, particularly those who were not qualified teachers; and second, our aim was to examine how these camp leaders included the values-based THRIVE philosophy in their day-to-day practice. Our findings show that, despite not being university-qualified educators, camp staff consistently employed intentional pedagogies that were effective in engaging students in opportunities to “thrive” in alignment with the philosophy underpinning their operations and to meet the goals of the school using their programs. Full article

Background/Objectives: Patient safety is directly linked with health and wellbeing of healthcare workers. In the UK, COVID-19 severely disrupted healthcare, with surgeons tackling prolonged waiting lists and working longer hours under high stress. This study explored the biomechanical and psychosocial demands on hospital surgeons, as well as their experience of pain and work-life balance post-pandemic. Methods: A questionnaire was developed combining validated tools assessing physical demands; modified job demand, control, and support; the WHO-5 wellbeing index; work–life balance from the Copenhagen Psychosocial Questionnaire; musculoskeletal pain; job satisfaction and retirement intentions. An online survey was developed using the Qualtrics© (Provo, UT, USA) platform and circulated through surgical networks using snowball sampling. Poisson regression modelling with robust confidence intervals was used to explore relationships between work-related factors and musculoskeletal pain, and associations with retirement intentions. Results: In total, 242 replies were received. Surgeons frequently reported strenuous occupational activities and work–life imbalance, and one in six reported job dissatisfaction. Only 17% reported no pain; the one-month prevalence of pain ranged from 46% at the lower back to 12% at the ankle, and pain was frequently disruptive. Better work–life balance had a protective effect for pain (PRR = 0.92, 95% CI = 0.85–0.99), while risk of pain increased with increasingly physically demanding activities at work (PRR = 1.04, 95% CI = 1.01–1.07) in the age- and sex-adjusted models. Job dissatisfaction was associated with intention to retire early (PRR = 1.83, 95% CI = 1.02–3.27). Conclusions: This study demonstrated high physical and mental demands among surgeons and poor work–life balance. Physical and emotional links to pain were identified. Fit surgeons ensure safe patient care. Our findings suggest that surgeons were facing health issues and work–life conflict post-pandemic, potentially limiting their job satisfaction and career span. A follow-up study is recommended. Full article

Guiding future awareness of and attitudes on the importance of nature and understanding environmental change is crucial for its future mitigation. A barrier to acting on issues such as climate change, however, is the time scale at which they occur and the lack of tangibility around key concepts such as the impact they have on phenotypic shifts in fauna and flora. Here, we assessed an environmental education intervention integrated into a mainstream curriculum that included cooperative learning and a practical environmental biology experiment. We aimed to understand if this intervention increased both the awareness of environmental change and intention to act in primary-school-aged children. We selected 150 students (5–11 years) from Oakhurst Community Primary School, UK, and assessed the intervention via the Draw-Our-Environment (DOE) test and an Environmental Perception Survey (EPS). We showed how a curriculum inclusive of more than tokenistic environmental education, developed through considering a combination of different active learning activities, favoured a clear increase in environmental awareness and intention to act. Via path analysis, we showed that an increase in environmental awareness (assessed via the DOE test) determined an increase in individual orientation on pro-environmental behaviours (assessed via the EPS). Experiential learning helps students to understand the physical processes of environmental change and increase awareness of environmental problems. This has the potential to alter perceptions of young people’s attitudes on the importance of and willingness to act against environmental change. Full article