Search Results (531)

Background and Objectives: Depression is a leading cause of disability globally, with treatment challenges including limited access, stigma, and poor adherence. Gamification, which applies game elements such as points, levels, and storytelling into non-game contexts, offers a promising strategy to enhance engagement and augment traditional treatments. Our research is the first study designed to explore the implementation of gamification within the Malaysian context. The objective was to explore the feasibility of implementation of gamification as an adjunctive treatment for adults with depression. Materials and Methods: Focus group discussions were held with five mental health professionals and ten patients diagnosed with moderate depression. The qualitative component assessed perceptions of gamified interventions, while quantitative measures evaluated participants’ depressive and anxiety symptomatology. Results: Three key themes were identified: (1) understanding of gamification as a treatment option, (2) factors influencing its acceptance, and (3) characteristics of a practical and feasible intervention. Clinicians saw potential in gamification to boost motivation, support psychoeducation, and encourage self-paced learning, but they expressed concerns about possible addiction, stigma, and the complexity of gameplay for some patients. Patients spoke of gaming as a source of comfort, escapism, and social connection. Acceptance was shaped by engaging storylines, intuitive design, balanced difficulty, therapist guidance, and clear safety measures. Both groups agreed that gamification should be used in conjunction with standard treatments, be culturally sensitive, and be presented as a meaningful therapeutic approach rather than merely as entertainment. Conclusions: Gamification emerges as an acceptable and feasible supplementary approach for managing depression in Malaysia. Its success depends on culturally sensitive design, robust clinical oversight, and seamless integration with existing care pathways. Future studies should investigate long-term outcomes and establish guidelines for the safe and effective implementation of this approach. We recommend targeted investment into culturally adapted gamified tools, including training, policy development, and collaboration with key stakeholders to realistically implement gamification as a mental health intervention in Malaysia. Full article

Background: Amid growing concerns about climate crisis and its psychological toll, understanding how people find meaning through their connection to nature is increasingly important. The first aim of this study is to examine the association between Nature Relatedness (NR) and Meaning in Life (MIL). The second aim is to investigate if gender moderates this association and to explore how Jewish traditions influence gender differences in this relationship. Methods: A multi-methods design was employed. Participants were recruited through purposive sampling of prominent Jewish community figures, followed by snowball sampling via informant referrals. Thirty-five participants completed the Meaning in Life Questionnaire (MLQ) and the NR Scale. Two questions provided qualitative insights into participants’ personal interpretations and culturally grounded meanings of NR and MIL in the context of climate change and Jewish traditions. Results: Hierarchical multiple regression analyses assessed the main effects of NR and gender, as well as their interaction, on MLQ subscales. NR positively correlated with the MLQ Search dimension, indicating that individuals with stronger NR actively seek meaning in life. Gender moderated this relationship: NR did not correlate with MLQ Presence overall, but higher NR was linked to greater MIL presence among female participants. Thematic analysis of qualitative responses revealed gender-based variations and emphasized the role of Jewish teachings in connecting NR to cultural and religious practices. Conclusions: The findings point to the importance of cultural, religious, and gender factors in shaping the relationship between NR and MIL in a time of climate change crisis, offering implications for positive mental health research and culturally sensitive interventions. Full article

Alternative proteins denote non-traditional, high-protein foods. These innovative sources aim to compete with conventional animal products by providing protein-rich, sustainable, nutritious, and flavorful options. Currently, five main categories of alternative proteins are being developed: plant-based proteins, cultured meat, single-cell proteins, edible insects, and seaweed. Nonetheless, several chemical and microbiological food safety hazards are associated with these alternatives Incorporating novel protein sources into food products may heighten the prevalence of existing food allergies. This could arise from extracting proteins from their natural matrices and utilizing them at significantly higher concentrations. Additionally, the introduction of new proteins may lead to the development of novel food allergies. Proteins that are currently seldom or never consumed may cause primary sensitisation or trigger cross-reactivity with known allergens. To date, alternative proteins have not been thoroughly studied for their allergenic potential, and there is no standardised method for assessing this risk. This review aims to explore non-traditional protein sources, discussing their nutritional and functional properties, as well as their potential allergenicity based on available research. We conducted a literature search in PubMed and Embase databases. We used specific keywords and MESH terms. A total of 157 studies were included in the review. The studies reviewed in our analysis reveal significant limitations, such as inconsistent methodologies, limited participant numbers, and a lack of long-term data, which hinder the ability to make clear conclusions regarding the safety of these new proteins for individuals with allergies. To address current challenge, future research should integrate food science, regulatory perspectives and advanced technologies. Full article

Background: As population aging accelerates, the demand for professionals in older adult care continues to rise. Traditional teaching methods often fail to improve students’ willingness to serve older adults or foster teamwork. This study evaluated the effects of integrating a flipped classroom with project-based learning (PBL) and a hands-on clinical practicum into a health internship course. Methods: A mixed-methods design was adopted. Participants included 88 interdisciplinary university students enrolled in an 18-week, two-credit geriatric health internship course offered at a university in central Taiwan from August 2023 to July 2024. The course combined flipped classroom and PBL approaches, as well as clinical practicum activities. Data on willingness to serve older adults, teamwork skills, and learning outcomes were collected using structured questionnaires and analyzed with paired t-tests. Results: Significant improvements were found in willingness (from 68.93 to 73.15), teamwork (67.33 to 71.45), and learning outcomes (89.84 to 102.14) (p = 0.001). Qualitative findings further revealed increased empathy, improved teamwork, and enhanced ability to apply knowledge in real-world contexts. Conclusions: A teaching approach that integrates a flipped classroom, PBL, and a clinical practicum can effectively enhance students’ competencies in older adult care. Future research should explore long-term and cross-cultural impacts. Full article

This research aims to determine the utilization levels of local products and the challenges and opportunities of creating a recognizable food-centered cultural identity based on collaborative networks developed between agriculture and tourism. This has the potential to strengthen collaborative entrepreneurship. It uniquely contributes to the existing literature by exploring the connections between agri-food and tourism, while proposing strategies to maximize business opportunities centered on food culture. Descriptive and inferential statistics are conducted based on primary data collected by distributing a questionnaire to 59 public and private organizations in the Peloponnese region in Greece, which has significant agricultural production but limited tourist flows. The results indicate a lack of collective action and business recognition of the value of regional food culture among participants. The human resources employed in tourism lack the skills to highlight traditional food heritage. The presence of structural and operational barriers undermines efforts to facilitate communication, manage suppliers, and enhance the visibility of products designated with Geographical Indications. This paper offers preliminary results; however, extensive future studies are needed to validate the findings fully. The study highlights key implications: Improved communication between stakeholders could enhance the management of the local food network. Agri-food and tourism businesses can develop educational programs and food-focused tourism packages that promote social cohesion and preserve cultural heritage. Full article

The Vâlcea Subcarpathians, known for their wealth of natural resources and their spa tradition, are distinguished by renowned spa resorts such as Băile Olănești, Călimănești, Ocnele Mari and Băile Govora. These destinations provide tourists with a variety of treatment, relaxation, and recreational options. This research aims to explore the factors influencing tourist behavior at spa resorts in the Vâlcea Subcarpathians, Romania. Specifically, the relationships between tourists’ residential environment and frequency of visits, the influence of participation in cultural activities on the average duration of trips, and the impact of information sources and vacation planning methods on why tourists choose to visit spa resorts in the Vâlcea Subcarpathians, Romania, will be examined. As part of this study, a questionnaire was developed to collect relevant data on the perceptions and behaviors of visitors to spa resorts in the Vâlcea Subcarpathians, Romania. To analyze the collected data and test the research hypotheses, the following statistical methods were used: Chi-Square Test, Independent Samples t-Test and Analysis of Variance (ANOVA). The results obtained from the statistical tests largely confirmed the proposed hypotheses. There is a significant relationship between the age range of tourists and the frequency of visits, suggesting that different age groups have distinct visiting behaviors. Also, the perception of service quality varies by the gender of tourists, indicating that men and women have different experiences and expectations. Full article

Startups are often praised for their innovative power and dynamic work environments, but are also criticized for workplace cultures that perpetuate traditional masculine norms of competitiveness, workaholism, emotional resilience, and strength. This exploratory study examines the prevalence of Masculinity Contest Culture (MCC) in German startups and related gender dynamics. The Masculinity Contest Culture scale, which assesses masculine norms related to emotional resilience, physical superiority, workaholism, and aggressive competitiveness, was employed to collect data from 101 participants representing various startups. The results indicate an overall low prevalence of MCC, with slightly higher scores for strong commitment to work. Individuals from disparate gender and hierarchical status groups exhibited comparable ratings of the intensity of toxic masculinity. While the presence of female founders and supervisors did not affect MCC scores, male dominance within the work environment had a small but significant amplifying effect. Significant differences were observed based on the prevailing leadership style, indicating that a shared leadership approach is associated with the creation of a more inclusive and less toxic work environment. The results challenge commonly held assumptions about tech startups. In addition, the study highlights the need for further research into the impact of leadership dynamics on startup culture. Full article

This qualitative case study explores Missouri-based consumers’ ethical beliefs regarding restaurant sourcing from minority farmers. Guided by the Hunt–Vitell theory of ethics (H-V model), it applies the model in a new context: culturally inclusive restaurant sourcing. Based on 15 semi-structured interviews conducted between September 2024 and October 2024, the study explores how ethical beliefs shape dining intentions. Participants generally viewed support for minority farmers as ethically appropriate. Thematic analysis revealed six key themes: (1) community-oriented social values (e.g., social responsibility toward local businesses); (2) cultural identity (e.g., traditional farming methods); (3) consumer values—food-oriented (e.g., quality); (4) consumer values—people-oriented (e.g., financial support for ethical sourcing); (5) trust-building mechanisms (e.g., sourcing transparency); and (6) barriers (e.g., lack of awareness). These findings highlight limited consumer awareness of minority farmers and the need for transparent communication and cultural education. The study contributes theoretically by extending the H-V model to the intersection of ethics, culture, and restaurant sourcing. Practically, it offers guidance for restaurant managers, marketers, and policymakers to support minority farmers, build trust, and promote inclusive and socially responsible dining. One key limitation of this study is its reliance on a small, Missouri-based consumer sample, which limits generalizability and excludes perspectives from other stakeholders. However, as a regional case study, it provides important depth and contextual insight into an underexplored aspect of sustainable sourcing. This study also highlights the need for multi-stakeholder engagement to advance equity in the food system. Full article

Gastrodia elata, known as Tianma in Chinese, is a valuable medicinal and nutritional resource. The favorable climate of Zhaotong City, Yunnan Province, China, facilitates its growth and nurtures rich biocultural diversity associated with Tianma in the region. Local people not only cultivate Tianma as a traditional crop but have also developed a series of traditional knowledge related to its cultivation, processing, medicinal use, and culinary applications. In this study, field surveys employing ethnobotanical methods were conducted in Yiliang County, Zhaotong City, from August 2020 to May 2024, focusing on Tianma. A total of 114 key informants participated in semi-structured interviews. The survey documented 23 species (and forms) from seven families related to Tianma cultivation. Among them, there were five Gastrodia resource taxa, including one original species, and four forms. These 23 species served as either target cultivated species, symbiotic fungi (promoting early-stage Gastrodia germination), or fungus-cultivating wood. The Fagaceae family, with 10 species, was the most dominant, as its dense, starch-rich wood decomposes slowly, providing Armillaria with a long-term, stable nutrient substrate. The cultural importance (CI) statistics revealed that Castanea mollissima, G. elata, G. elata f. flavida, G. elata f. glauca, G. elata f. viridis, and Xuehong Tianma (unknown form) exhibited relatively high CI values, indicating their crucial cultural significance and substantial value within the local community. In local communities, traditionally processed dried Tianma tubers are mainly used to treat cardiovascular diseases and also serve as a culinary ingredient, with its young shoots and tubers incorporated into dishes such as cold salads and stewed chicken. To protect the essential ecological conditions for Tianma, the local government has implemented forest conservation measures. The sustainable development of the Tianma industry has alleviated poverty, protected biodiversity, and promoted local economic growth. As a distinctive plateau specialty of Zhaotong, Tianma exemplifies how biocultural diversity contributes to ecosystem services and human well-being. This study underscores the importance of biocultural diversity in ecological conservation and the promotion of human welfare. Full article

This article describes the design and implementation of a Specialized Mental Health Clinical Pastoral Education (CPE) program for clergy and theological students of all spiritual, religious, and cultural backgrounds. Addressing the need for mental health competencies in religious leaders and chaplains, this training equips participants with specialized skills in individual and group mental health spiritual assessment and spiritual care. Program participants become effective members of a multiprofessional team, gain knowledge of mental health philosophies of concordant and discordant spiritual orienting systems, and gain greater relational capacity. The Mental Health CPE Program includes traditional and novel CPE elements: (1) clinical practice, (2) group and individual supervision, (3) didactic presentations and journal clubs, (4) verbatim (Protocols of patient encounters) and case presentations, (5) group leadership training and practica, and (6) experience of faith reflections. This article provides insights into the origins of CPE, a description of the implementation in a free-standing psychiatric hospital, and observed developmental changes of program participants. We include graduates’ anecdotal feedback about their learning experience and its impact on their leadership in chaplaincy and in religious communities. Additionally, we report on areas for future development and further study of the effectiveness of Mental Health CPE. Full article

Background and Objectives: The spontaneous reporting (SR) of adverse drug events (ADEs) is a cornerstone of pharmacovigilance and a critical mechanism for safeguarding patient safety. However, underreporting remains a persistent global challenge. In Korea, despite the widespread use of herbal medicines (HMs), adverse event reports from traditional Korean medicine doctors (KMDs) are remarkably scarce. This study aimed to assess the knowledge, attitudes, and experiences of KMDs regarding SR, identify key barriers, and suggest strategies to strengthen the safety culture within traditional Korean medicine. Materials and Methods: A cross-sectional, anonymous online survey was distributed to licensed KMDs registered with the Association of Korean Medicine. The questionnaire collected information on respondents’ sociodemographic characteristics and assessed their knowledge, attitudes, and experiences related to ADE reporting. Descriptive statistics and multivariate logistic regression were used to analyze the associations between the variables. Results: Of the 1021 KMDs who completed the survey, the vast majority acknowledged the importance of SR and recognized their role in pharmacovigilance. Nevertheless, only 5% had ever submitted an ADE report. A widespread lack of awareness about the national spontaneous reporting system (SRS), particularly its inclusion of licensed HMs, was evident. Although many respondents expressed support for expanding the scope of SR to cover all HMs, significant gaps in pharmacovigilance knowledge and limited access to relevant training were major barriers. KMDs affiliated with academic institutions or specialist groups showed higher levels of awareness, education, and reporting behavior. Conclusions: While KMDs exhibit positive attitudes toward patient safety and understand the importance of SR, their participation in it remains low due to knowledge deficits and insufficient training. Addressing these gaps through targeted education and expanding the national SRS to comprehensively include herbal medicines are essential steps toward enhancing pharmacovigilance and cultivating a proactive safety culture in Korean medicine. Full article

American adults struggle with accurately assessing the quality of their diet, with the majority overrating their diet quality. Thus, the objective of the study was to explore what individuals think about when asked to rate their diet quality. Virtual focus groups were conducted from October 2023 to April 2024, using a semi-structured interview with open-ended questions. Convenience samples of small-scale farmers, school food service directors, health clinic patients, and university students and staff in Mississippi and Arkansas participated (N = 27). Themes and subthemes from NVivo-transcribed discussions were identified and coded inductively. Four subthemes emerged for description of diet: balance, consideration for others, convenience, and location. Four subthemes emerged for quality of diet: availability/access, culture/tradition, health considerations, and making better choices. Three subthemes emerged for healthy food: composition/preparation, nourishing benefits, and taste/flavor. Three subthemes emerged for unhealthy food: addicting/overconsumption, composition/preparation, and undesirable effects. Three subthemes emerged for nutrition knowledge: audience specific, general knowledge, and ambivalence. Three subthemes emerged for food shopping: food types, family influence/preference, and planning. Factors shaping how individuals perceive their diet quality are complex with intertwining components. Understanding the complexity involved in self-perceptions of diet quality will help us better quantify perceptions and link them to measurable outcomes. Full article

Background: The Lingnan region is characterized by a hot and humid climate and abundant, diverse natural resources, while the Central Plains region experiences distinct four seasons and has a rich agricultural culture. Both regions possess unique dietary traditions and preferences. This study aims to investigate the differences in dietary structure between the Lingnan region (Guangdong, Guangxi, Hainan) and the Central Plains region (Shanxi, Shaanxi, Henan) and their impact on health. Methods: Using cross-sectional survey data from the 2015–2017 China National Nutrition and Health Survey, this study selected residents aged 18 and above as the research subjects. Generalized linear models were employed to analyze differences in the intake of various food groups between the two regions, while logistic regression models were used to examine regional differences in the prevalence of obesity, hypertension, diabetes mellitus, and hyperlipidemia. Results: A total of 14,484 adults were included in this study. Lingnan participants consumed significantly more rice products, red meat, poultry, seafood, and dark-colored vegetables, while Central Plains residents had higher intakes of wheat products, other cereals, soybeans, and eggs. Lingnan exhibited lower prevalence rates of obesity (8.6% vs. 18.1%), diabetes (7.6% vs. 9.8%), and hypertension (33.0% vs. 46.9%) compared to the Central Plains, with no significant difference in hyperlipidemia prevalence. Adjusted analyses confirmed that Lingnan residents had significantly reduced risks of obesity (OR = 0.431, 95% CI: 0.388–0.479), diabetes mellitus (OR = 0.841, 95% CI: 0.744–0.950), and hypertension (OR = 0.564, 95% CI: 0.523–0.608). Conclusions: The dietary structure in the Lingnan region plays a positive role in cardiometabolic health. Further analysis of the combined effects of different foods on health could provide a scientific basis for future nutrition and health management. Full article

This study examines Lombardy’s response to the Ukrainian migration crisis which was triggered by the conflict between Russia and Ukraine. It focuses on the on the innovative experience of refugee reception that emerged as the traditional system became overwhelmed. It analyzes which aspects proved effective and which did not in the development of this alternative approach and the collaboration among various actors. Qualitative data were collected through semi-structured interviews with 28 participants, including professionals from both traditional reception systems and new collaborative actors and entities. Results highlight four specificities of the Ukrainian migration: geographic and cultural proximity, the demographic composition (predominantly women and children), positive media portrayal, and the activation of new actors. The study delves into six motivations driving this collaborative effort, ranging from historical ties, and pre-existing communities to emotional involvement and a perceived urgency for support. The challenges in coordinating between traditional systems and new collaborative entities are also examined, including communication barriers, the need for flexibility, and the lack of clear guidelines. This study recommends establishing a steering committee for enhanced collaboration and emphasizes the importance of long-term sustainability of these collaborative efforts. The findings offer valuable considerations for managing migration emergencies and fostering collaboration between different organizations and stakeholders. Full article

Background/Objectives: The place where a person dies serves as an indicator of end-of-life care quality. This study aims to identify the congruence of place of death (POD) and the reasons behind decision-making among terminally ill cancer patients in East Asia. Methods: We conducted a prospective multicenter cohort study in palliative care units in Japan, Korea, and Taiwan. Data were collected by the responsible physicians during routine clinical practice. Sankey diagrams were applied to present changes in reasons for POD incongruence. Results: A total of 2638 participants from 37 palliative care units in the three countries were enrolled, and most of them died at PCUs (Japan: 95.7%, Korea: 94%, Taiwan: 82%, p < 0.05). The congruence rate of the preferred and actual POD among PCU inpatients ranged from 70% to 80%. Availability of end-of-life care is the most common reason for preferred and eventual PCU death (78.6%, 72.2%, and 52.1%, respectively, p < 0.05). However, 13–22% of patients admitted to PCUs still preferred to die at home, for which traditional culture (20.2%, 40.8%, and 82%, respectively, p < 0.05) or family influence (44.4%, 38.8%, and 51.7%, respectively, p > 0.05) are the main reasons. Cultural and environmental factors, such as influences from family members’ preferences in the three countries or the ownership of housing/housing settings in Japan, are the main challenges in achieving POD congruence. Conclusions: Culturally inclusive strategies in clinical practice and policy implementation for identifying the preferred POD, enhancing communication among stakeholders, and facilitating transitional support may improve the quality of goal-concordant care. Full article