Search Results (9,987)

This study explores how Artificial Intelligence (AI) shapes Green Purchasing Behavior through cognitive and attitudinal mechanisms by implementing the Stimulus–Organism–Response (SOR Model) Theory. It analyzes AI as an external stimulus that influences Environmental Knowledge and Green Truth, which, in turn, affects Environmental Attitudes and Green Purchasing Behavior. A cross-sectional quantitative design was employed using survey data collected from 412 consumers in the province of Guayas (Ecuador). The data were analyzed using partial least-squares structural equation modeling (PLS-SEM). The results indicate that AI exerts a weak influence on Green Purchasing Behavior; instead, its impact operates primarily through indirect pathways. Specifically, AI significantly enhances Environmental Knowledge and promotes Green Truth, subsequently shaping consumers’ Environmental Attitudes. Furthermore, Environmental Attitude emerged as the strongest predictor of Green Purchasing Behavior, confirming its central role in translating internal evaluations into consumption decisions. These findings contribute to the literature by integrating AI into sustainable consumption models and demonstrate that its effectiveness depends on its ability to generate credible and meaningful internal responses rather than directly influencing behavior. Full article

This study analyzes how identity fit, narrative selection, co-creation, and AI-Enhanced Interpretation (AII) shape Tourist Active Heritage Engagement in Ecuador. Using a cross-sectional survey of 1336 international tourists and PLS-SEM with Multigroup Analysis, the results show that engagement is driven primarily by identity-based selection, rather than participation alone. MGA reveals a marked asymmetry: AII increases engagement and co-creation only among visitors with high technological readiness, whereas for low-readiness tourists, co-creation may even diminish engagement. These patterns expose digital inequalities and asymmetries in narrative agency, echoing UNESCO’s concerns about AI’s selective influence on cultural knowledge flows. Overall, the study demonstrates that co-creation operates conditionally within identity-driven processes and underscores the need for inclusive, differentiated interpretive strategies. Full article

Background: The Older Americans Act (OAA) home-delivered and congregate meal programs and related nutrition services are the largest federal programs in the United States (U.S.) to reduce malnutrition (undernutrition) among community-dwelling older adults. However, the prevalence of undernutrition has received little attention in the OAA programs, while many studies report the prevalence of overweight and obesity. Objective: We documented undernutrition risk prevalence estimates post-COVID-19 in a 2023 nationally representative survey of OAA participants in the U.S. Undernutrition risk prevalence may have been elevated among those surveyed previously in 2022 because data were collected during the COVID-19 pandemic. Methods: Data were obtained from the 2023 National Survey of Older Americans Act Participants (NSOAAP) (n = 4159); a cross-sectional survey of OAA participants randomly selected from a stratified sample of Area Agencies on Aging throughout the U.S. The NSOAAP included measurement of undernutrition risk, the main outcome of interest, using the Malnutrition Screening Tool (MST) that queried self-reports of unintended weight loss and decreased food intake due to poor appetite. MST scores ≥ 2 were defined as indicating undernutrition risk. Data were reported using confidence intervals. Results: In 2023, nearly 1 in 5 NSOAAP respondents were at undernutrition risk; 9.9% (95% CI 7.3–13.0%) of congregate meal participants, 20.8% (95% CI 18.3–23.5%) of home-delivered meal participants, and 21.3% (95% CI 16.7–26.4%) of participants in OAA non-nutrition programs (transportation, case management, or homemaker services). Participants in different OAA program types also differed in many demographic and health-related characteristics. Conclusions: Since undernutrition risk is neither a definitive diagnosis of undernutrition nor its causes, it must be followed up by further nutrition assessment. Full article

Background/Objectives: The lumbopelvic complex plays a key role in postural regulation, core stabilisation and biomechanical coordination of spinal and pelvic alignment. The aim of the study was to analyse relationships between lumbopelvic complex alignment defects and temperament types in adolescents, and to evaluate their potential relevance for more individualised prevention and rehabilitation strategies. Methods: The study is of a cross-sectional design. The research included 273 adolescents aged 16–17 years. Body posture was assessed using the DIERS Formetric III 4D system based on rasterstereography. Temperament traits were evaluated using the Pavlovian Temperament Survey (PTS). Results: Body posture in the examined adolescents was characterised by high variability, and the majority of participants presented abnormalities in lumbopelvic alignment and spinal curvatures. The most common finding was flattening of physiological spinal curvatures, particularly reduced thoracic kyphosis coexisting with normal or reduced lumbar lordosis. No significant associations were found between temperament and most of the analysed postural parameters. Significant differences were identified only for the pelvic torsion DL–DR parameter (H = 9.96; p = 0.019). Pelvic torsion DL–DR values were significantly higher in the sanguine temperament group compared to the phlegmatic (p = 0.013) and choleric groups (p = 0.015). Higher values of this parameter were also observed in adolescents with a melancholic temperament. Conclusions: Temperament may selectively influence mechanisms underlying lumbopelvic complex control, particularly regarding the pelvic torsion DL–DR parameter. Incorporating temperamental characteristics into postural diagnostics may support the development of more individualised prevention and rehabilitation programmes aimed at improving core stabilisation, motor control and functional control of the lumbopelvic complex in adolescents. Full article

Background: Autism spectrum disorder (ASD) is consistently associated with a high prevalence of sleep disturbances across the lifespan, with reported rates ranging from 60% to 86% depending on age and clinical characteristics. Although this issue has been widely described in the international literature, Spain currently lacks large-scale data to estimate the prevalence of sleep disturbances or to examine their relationship with factors such as age, intellectual disability, and co-occurring conditions. This study aims to estimate the prevalence and severity of sleep disturbances in individuals with autism spectrum disorder in Spain and to examine their associations with developmental stage, intellectual disability, affective symptoms, and contextual factors. Methods: This is a cross-sectional observational survey with nationwide dissemination approved by the Ethics Committee of the Universidad Católica San Antonio de Murcia. Data will be collected through an online survey (SurveyMonkey) including validated instruments: the Children’s Sleep Habits Questionnaire–Autism (CSHQ-Autism) and the Sleep Disturbance Scale for Children (SDSC) for pediatric participants; the Pittsburgh Sleep Quality Index (PSQI) for adolescents and adults without intellectual disability; and the Diagnostic Assessment for the Severely Handicapped–II (DASH-II) for adults with intellectual disability. Anxiety and depressive symptoms will be assessed using the Child Behavior Checklist (CBCL) in children and adolescents and the Hospital Anxiety and Depression Scale (HADS) and DASH-II. Statistical analyses will be conducted using SPSS v22 by applying parametric or non-parametric tests according to data distribution. Conclusions: This study represents one of the first survey protocols with nationwide dissemination designed to assess sleep disturbances in individuals with ASD in Spain. The resulting findings are expected to help identify vulnerability profiles, inform public health strategies, and support the development of multidisciplinary interventions aimed at improving sleep and, consequently, the quality of life of individuals with autism and their families. Full article

Background/Objectives: Low back and neck pain are common musculoskeletal complaints among healthcare workers, including anesthesia providers. This study aims to quantify the prevalence of back and neck pain amongst anesthesiology providers to identify risk factors, mechanisms of injury, and recovery practices to guide preventative measures. Methods: A cross-sectional survey of anesthesiology clinicians in a multi-site academic healthcare system in New York City was administered using REDCap version 12.5.9. The recorded survey results were aggregated to determine percentages for each question. Descriptive statistics were used to determine the nature of low back and neck pain and detail causes. Oswestry Disability Index (ODI) and Neck Disability Index (NDI) scores were calculated. Results: The survey instrument was distributed to 380 anesthesiology clinicians at four separate institutions and yielded 191 responses for a response rate of 50.3%. Fifty-three-point-nine percent of survey respondents reported having current back or neck pain, with the majority reporting that it was chronic (87.4%). A substantial proportion of respondents reported not having back or neck pain prior to training (58.3%), and the majority reported that their back or neck pain was work-related (54.1%). Only 14.1% of respondents reported having had training in back or neck pain prevention. The most common location of pain was lumbar (81.6%). The most common inciting event for work-related pain was patient transfer/transport (68.6%). For ODI scoring, 98% of clinicians within the health system were classified as minimal disability and 2% of clinicians as moderate disability. For NDI scoring, 95.8% of clinicians were classified as minimally disabled, with 2.6% classified as moderate disabled. Conclusions: Back and neck pain are common pathologies amongst anesthesia providers. For most clinicians, the pain began to occur during training. Common inciting events include patient transfer/transport, procedure performance, and room setup. This provides a framework with which preventative practices can take place to reduce the prevalence of back and neck pain in anesthesiology and other related health care disciplines. Full article

Background: Serum concentrations of 25-hydroxyvitamin D [25(OH)D] are associated with the risk of several chronic and acute diseases. However, updated data on vitamin D status in Mediterranean countries, including Italy, remain limited, hindering effective public health strategies. Objective: To assess serum 25(OH)D levels and their seasonal variation in healthy blood donors aged 18–65 years living in Northern Italy and not taking vitamin D supplements. Given the latitude and the high levels of environmental pollution, cutaneous vitamin D synthesis may be impaired in this population. Recent Italian guidelines on supplementation emphasize the need for updated data on the prevalence of hypovitaminosis D and seasonal variation in endogenous vitamin D synthesis. Methods: In this exploratory retrospective cross-sectional study, 534 blood donors (268 men and 266 women) attending the Transfusion Medicine Unit of the Verona University Hospital were enrolled between April 2016 and May 2018. Serum 25(OH)D concentrations were analyzed by season. Clinical, lifestyle, pharmacological and dietary characteristics were also collected. Results: Among healthy, normal-weight individuals, the prevalence of vitamin D insufficiency (25(OH)D < 50 nmol/L) was low and limited to one-two months per year. Overweight and obesity significantly reduced the likelihood of achieving adequate 25(OH)D levels through cutaneous synthesis for several months. Mean 25(OH)D concentrations were higher than those previously reported in the same area, while seasonal variation remained preserved. Conclusions: In a relatively small non-supplemented population of blood donors living in a high polluted urban area of Northern Italy, seasonal vitamin D synthesis seems to be preserved. These updated data show higher 25(OH)D levels compared to past findings. Although these data certainly warrant further validation through a national survey involving other regions of Italy and in not selected population, they appear to be in line with the SIOMMMS recommendations against indiscriminate serum 25(OH)D testing and against routine supplementation for healthy normal-weight individuals under 70 years. Full article

Background: Specialized palliative care requires nursing professionals to address the complex physical, psychological, social and spiritual needs of patients with advanced incurable illness. This study aimed to assess the perceived adequacy of formal educational preparation among nurses working in specialized palliative care services in the Republic of Croatia and examine its association with self-assessed knowledge and the perceived need for additional education. Methods: A nationwide cross-sectional survey was conducted among nursing professionals employed in specialized palliative care services across Croatia. Data were collected using a structured questionnaire assessing sociodemographic characteristics, perceived adequacy of formal education, self-assessed knowledge, as well as the need for additional education in physical, psychological, social and spiritual care domains. An Educational Sufficiency Discrepancy Index (ESDI) was calculated to quantify the difference between perceived educational sufficiency and continuing education needs. For inferential statistics significance was set at p < 0.05 (two-tailed). Results: Among the 194 nursing professionals who participated in the study, perceived educational sufficiency was highest in the physical domain (87.5%), where it exceeded the reported need for additional education (31.6%). Negative discrepancies were observed in social (–12.9) and spiritual care (–17.6), indicating perceived educational deficits. Representation of physical care content in formal education was significantly associated with higher self-assessed knowledge across several domains (physical p < 0.001; psychological p = 0.008; social p < 0.001; spiritual p = 0.008). No significant associations were found between self-assessed knowledge and age, work experience or level of education. Conclusions: Formal nursing education alone may not fully meet the multidimensional competency requirements of specialized palliative care practice. Strengthening structured continuing professional development, particularly in psychosocial and spiritual care, may support holistic palliative care delivery and sustained professional competence. Full article

Gastrointestinal nematodes (GIN) continue to impose substantial health and productivity losses in grazing ruminants, and the accelerating emergence of anthelmintic resistance (AR) underscores the need for SWC strategies. Although multiple SWC approaches have been validated experimentally, their implementation across European livestock systems remains inconsistent, and limited evidence exists regarding the stakeholders’ perceptions that affect decision-making. This study conducted a multilingual cross-sectional survey of 1261 respondents, including farmers, veterinarians, advisors, and other professionals, across 13 European countries to evaluate perceived worm-control cost burdens and the economic feasibility of seven SWC strategies. Descriptive and regression analyses revealed that a majority of respondents (56.7%) considered diagnostic testing to be financially reasonable, although perceptions varied significantly between countries. Sustainable anthelmintic use, quarantine and strategic screening, and grazing management were perceived as the most viable strategies, whereas biological control and bioactive compound-based approaches elicited greater uncertainty. An aggregated SWC Attitude Score demonstrated systematically higher acceptance among veterinarians compared to farmers, while male and older respondents exhibited lower levels of agreement across practices. The overall findings suggest that economic considerations may not be perceived as the primary barrier to sustainable worm control adoption, but other practical factors may potentially limit implementation. Full article

International students in Saudi universities face academic and adaptation challenges shaped by emotional, cognitive, linguistic, and sociocultural factors. This study examined whether emotional intelligence and cognitive flexibility predicted academic success and adaptation outcomes among international students in Saudi public universities. A quantitative cross-sectional survey was conducted with 410 international students using structured measures of emotional intelligence, cognitive flexibility, academic success, adaptation outcomes, Arabic proficiency, and sociodemographic characteristics. Data were analysed using descriptive statistics, chi-square tests, Kendall’s tau-b correlations, hierarchical regression, and observed-variable path analysis. Duration of residence was significantly associated with Arabic proficiency, χ²(8) = 82.40, p < .001. Arabic proficiency was positively associated with GPA, τ = 0.62, p < .001, and adaptation outcomes, τ = 0.48, p < .001. In hierarchical regression, sociocultural covariates and psychological predictors explained substantial variance in academic success, R² = 0.53, and adaptation outcomes, R² = 0.53. Emotional intelligence and cognitive flexibility remained positive predictors of both outcomes after accounting for Arabic proficiency, duration of residence, region of origin, and language of instruction. Findings suggest that international student success in Saudi universities reflects an interaction of emotional, cognitive, linguistic, and contextual resources. Universities should strengthen integrated support for emotional regulation, adaptive thinking, Arabic-language development, and culturally responsive academic guidance. Full article

The COVID-19 pandemic prompted governments to implement lockdowns and social distancing measures to curb transmission, which, in South Africa, disrupted economic activity, reduced household income, and challenged the sustainability of household food access. This study assessed food accessibility, availability, dietary diversity, food security status, and coping strategies among households in the Tygerberg region during lockdowns. A cross-sectional design was employed using a researcher-administered questionnaire to collect sociodemographic and household data. Food security was assessed using the Household Food Insecurity Access Scale and the Household Food Security Survey Module, dietary diversity using a 24 h recall, and coping strategies through a standardized tool. Among the 432 households surveyed, 62% reported reduced income during lockdowns, while approximately 80% experienced food insecurity in the preceding 30 days and 72% over the past year. Dietary diversity was low in 47.3% of households, consuming fewer than seven food groups, and medium in 46.4%, consuming eight to eleven food groups. Common coping strategies included purchasing cheaper, less preferred foods, skipping meals, and reliance on social relief measures such as food parcels and the Social Relief of Distress grant. Overall, while food availability remained relatively stable, economic access emerged as the principal constraint, undermining dietary quality and household resilience and highlighting the need for income-responsive and socially sustainable food security interventions to strengthen urban food system resilience during prolonged socio-economic shocks. Full article

There is a lack of comprehensive studies investigating the combined effect of resilience and emotional intelligence on the experience of bullying. Students’ well-being is based on skills such as psychological resilience and emotional intelligence. Thanks to these skills, problems like bullying are reduced, and students thrive. The aim of this study was to examine the associations between school bullying/victimization, psychological resilience, and emotional intelligence in primary school students, within the context of psychosocial factors related to school inclusion. In the present cross-sectional study, 121 primary school students (54 boys, 67 girls), aged 8–12 years, were surveyed using a self-report questionnaire to investigate the relationship between emotional intelligence, psychological resilience, and school bullying/victimization. A moderate positive correlation was found between victimization and bullying (ρ(119) = 0.34, p < 0.001), while victimization was moderately and negatively associated with resilience (ρ(119) = −0.35, p < 0.001). Emotional intelligence showed weak and non-significant associations with victimization and resilience, whereas its correlation with bullying was positive but small in magnitude (ρ(119) = 0.18, p = 0.048). Overall, resilience appears to be inversely related to victimization, while emotional intelligence demonstrated limited explanatory value in this sample. These findings highlight the potential protective role of resilience against victimization and underscore the importance of resilience-focused interventions within school settings. Emotional intelligence, although theoretically relevant, demonstrated limited explanatory value in this sample. Full article

Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition frequently associated with psychiatric comorbidity, including disordered eating. Adult women remain under-recognized and underrepresented in ADHD research, and emerging evidence suggests that symptom expression may be shaped by gendered social factors, ovarian hormone fluctuations, and metabolic health. In this manuscript, we provide a gender-focused theoretical overview of the literature linking ADHD to binge eating symptoms in adult women, with attention to underdiagnosis, menstrual cycle-related symptom variability, and obesity-related metabolic risk, and empirically test the association between a self-reported ADHD diagnosis and binge eating symptoms in an online cross-sectional sample of adult women. Women reporting an ADHD diagnosis (n = 140) were compared with a random subsample of n = 140 women without ADHD drawn from the same survey; comparability between groups on age, education, and employment was formally verified; and binge eating symptoms were assessed with the Binge Eating Scale (BES) as a continuous outcome and as an ordered three-category variable. Women reporting an ADHD diagnosis showed significantly higher BES scores than controls (rank-biserial r = 0.28, 95% CI 0.15–0.41), and a higher proportion of severe binge eating symptomatology (BES ≥ 27; 22.1% vs. 11.4%; OR = 2.20, 95% CI 1.14–4.25) than controls. The association remained significant in a sensitivity analysis adjusting for age and BMI. Taken together, our findings support the need for routine, gender-sensitive screening for binge eating symptoms in women with ADHD, as well as ADHD screening in women presenting with binge eating and obesity. Full article

Asthma is a chronic respiratory disease with uneven prevalence across population groups. This study investigated the associations between socioeconomic status, health behaviours, and environmental exposures and asthma prevalence across European countries. We conducted a cross-sectional analysis using data from the European Health Interview Survey (EHIS) covering wave III (2019). The sample included 223,453 adults aged 20 or older from 26 European countries. Asthma prevalence was self-reported. Socioeconomic variables included education and employment status, while behavioural factors included smoking and overweight status. Environmental exposures encompassed urbanisation and air pollution. Multilevel logistic regression models examined associations between asthma prevalence and its socioeconomic, behavioural, and environmental factors. Asthma prevalence was higher among individuals with lower educational attainment (OR = 1.30; 95% CI: 1.20–1.40), those who were unable to work due to long-standing health problems (OR = 2.27; 95% CI: 2.04–2.52), and retired individuals (1.44; 95% CI: 1.31–1.57). Individuals with pre-obesity and obesity had increased odds of asthma (OR = 1.13; 95%CI: 1.07–1.19, and OR = 1.76; 95%CI: 1.66–1.86, respectively). Urbanisation (OR = 1.13; 95%CI: 1.07–1.19) and exposure to air pollution (CO₂ and PM_2.5) were both significantly associated with higher asthma prevalence. Six countries exhibited a significant deviation from the average asthma prevalence. Inequalities in asthma prevalence in Europe were linked to socioeconomic disadvantage, unhealthy behaviours, and adverse environmental conditions. Some variability in asthma prevalence was independent of individual characteristics. These findings highlight the need for integrated public health policies that address the structural, behavioural, and environmental determinants of respiratory health. Full article

The rapid expansion of generative artificial intelligence (AI) is transforming higher education and creating new opportunities that are associated with the development of perceived professional competencies. At the same time, the accounting profession increasingly requires graduates who can evaluate sustainability disclosures and form informed judgments regarding sustainability-related information. However, limited research has examined how AI-supported learning relates to sustainability-oriented decision-making capabilities in accounting education. Drawing on Decision Support Systems (DSS) theory and constructivist learning theory, this study examines the associations between generative AI-supported learning and students’ perceived sustainability judgment capability. Specifically, the study investigates the mediating roles of perceived critical thinking and perceived sustainability knowledge, as well as the moderating role of AI literacy. A quantitative, cross-sectional research design was employed using self-reported survey data collected from 721 accounting students, and the proposed relationships were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). The findings indicate that generative AI-supported learning is positively associated with students’ perceived critical thinking and perceived sustainability knowledge. In turn, both constructs show significant positive relationships with perceived sustainability judgment capability, with perceived sustainability knowledge demonstrating a stronger association. Additionally, AI literacy strengthens the relationships between generative AI-supported learning and the cognitive constructs. Importantly, the study captures students’ self-reported perceptions of their cognitive and judgment-related capabilities and does not assess objective cognitive performance or demonstrated judgment ability. The study contributes to the literature by positioning generative AI as an educational decision-support mechanism associated with perceived sustainability-oriented judgment capability through cognitive pathways, while highlighting the importance of aligning theoretical claims with perceptual measurement approaches. Full article