Search Results (4,505)

Natural bioactive compounds found in Momordica charantia including polysaccharides, saponins, polyphenols, alkaloids, and notably polypeptide-p (often referred to as “plant insulin”)—have shown promising potential in shaping nutritional and therapeutic strategies for managing diabetes, metabolic disorders, and other nutrition-related diseases. Both retrospective and prospective analyses of bitter gourd’s functional properties such as its antioxidant, antitumor, immunomodulatory, and antibacterial effects highlight its innovative use as a food ingredient in developing targeted nutritional therapies. Assessing its applicability in the food industry, particularly through the fortification of products with bitter gourd powders, pulp, juice, or extracts, could enhance consumer acceptance and elevate the perceived quality of nutritionally superior foods. The nutrifunctional attributes revealed by its nutritional profile support the strategic integration of bitter gourd into various food formulations, contributing to a broader and more diverse range of dietary options. This diversification is especially valuable in addressing the dietary monotony often associated with diabetic nutrition plans, which continue to present significant challenges. The foundation laid by this review drawing on both theoretical insights and practical applications serves as a springboard for future research into the fortifying potential of bitter gourd-based preparations. Ultimately, such products may be recommended not only as nutritional supplements but also as part of clinical and hygienic-dietetic practices. Full article

Background: Lifestyle behaviours, such as dietary patterns, sleep quality, perceived stress, and physical activity, are closely interconnected and play a critical role in maintaining health and well-being. Among school teachers, a profession marked by high psychosocial demands, the interplay between these factors warrants further exploration. Objective: This pilot study aimed to explore the associations between adherence to the Mediterranean Diet (MD), sleep quality, perceived stress, and physical activity levels among Portuguese primary and secondary school teachers. Methods: A cross-sectional study was conducted between April and December 2023. Participants completed validated self-reported instruments, including the MD Adherence Screener (MEDAS), the Pittsburgh Sleep Quality Index (PSQI), the Perceived Stress Scale (PSS-10), and the short form of the International Physical Activity Questionnaire (IPAQ-SF). Correlational analyses and multivariable linear regression models were applied to explore the relationships among the variables. Results: Among the 50 teachers, 32% demonstrated high adherence to the MD, 60% reported good sleep quality, 62% experienced moderate stress, and 44% engaged in high physical activity. Women were more likely to adhere strongly to the MD (p = 0.012). Higher MD adherence was positively associated with physical activity (ρ = 0.343; p = 0.015). A positive correlation was observed between perceived stress and poorer sleep quality (ρ = 0.346, p = 0.014), and a negative correlation between perceived stress and physical activity levels (ρ = −0.297, p = 0.036). Despite reporting good sleep quality, these participants had higher perceived stress scores (p = 0.015). In adjusted models, sleep quality was the only significant predictor of perceived stress (B = 0.708; p = 0.003), and vice versa (B = 0.267; p = 0.003), suggesting a bidirectional relationship. Conclusions: The findings highlight the interrelation between dietary pattern, sleep stress, and physical activity in a professional group vulnerable to lifestyle-related health challenges. Although the sample size limits generalisability, this study provides preliminary evidence supporting the need for integrated health promotion strategies targeting stress reduction and lifestyle optimisation among educators. Full article

Objective: The objective of this study was to compare the performance and robustness of a deep learning reconstruction method against established alternatives for soft tissue CT image reconstruction. Materials and Methods: Images were generated from portal venous phase chest–abdomen–pelvis CT scans (n = 99) acquired on a dual-layer spectral detector CT using filtered back projection, iterative model reconstruction (IMR), and deep learning reconstruction (DLR) with three parameter settings, namely ‘standard’, ‘sharper’, and ‘smoother’. Experienced raters performed a quantitative assessment by considering attenuation stability and image noise levels in ten representative structures across all reconstruction methods, as well as a qualitative assessment using a four-point Likert scale (1 = poor, 2 = fair, 3 = good, 4 = excellent) for their overall perception of ‘smoother’ DLR and IMR images. One scan was excluded due to cachexia, which limited the quantitative measurements. Results: The inter-rater reliability for quantitative measurements ranged from moderate to excellent (r = 0.63–0.96). Attenuation values did not differ significantly between reconstruction methods except for DLR against IMR in the psoas muscle (mean + 3.0 HU, p < 0.001). Image noise levels differed significantly between reconstruction methods for all structures (all p < 0.001) and were lower than FBP with any DLR parameter setting. Image noise levels with ‘smoother’ DLR were predominantly lower than or equal to IMR, while they were higher with ‘standard’ DLR and ‘sharper’ DLR. The ‘smoother’ DLR images received a higher mean rating for overall image quality than the IMR images (3.7 vs. 2.3, p < 0.001). Conclusions: ‘Smoother’ DLR images were perceived by experienced readers as having improved quality compared to FBP and IMR while also exhibiting objectively lower or equivalent noise levels. Full article

Aim: We aimed to assess the impact of a Health and Nursing course on the professional commitment of first-year undergraduate nursing students and obtain quantitative and qualitative feedback on teaching. Design: This study employed a quasi-experimental design. Methods: Fifty first-year undergraduate nursing students who attended the Health and Nursing course were recruited. A self-designed basic information questionnaire, the Nursing Professional Commitment Scale, the Students’ Perceived Teaching Quality Questionnaire, and two quick open-ended questions were used to collect the data. Professional commitment before and after the intervention was compared using an independent samples t-test. The correlation between the students’ perceived teaching quality and professional commitment was assessed using Pearson’s correlation coefficient. Content analysis was used to analyze qualitative feedback. Results: The participants experienced a significant improvement in their professional commitment. The students’ perceived teaching quality was significantly correlated with their professional commitment. According to the students’ feedback, the most impressive aspects of the course were case-based learning and visits to healthcare institutions. Conclusions: A Health and Nursing course with high-quality teaching increased the professional commitment of first-year undergraduate nursing students. The findings suggest that nursing educators should consider the external macro-sociopolitical environment when designing an introductory course to equip students with a broader perspective on nursing professional development. Teaching content and pedagogy should be improved to promote knowledge delivery and internalization. Full article

Background: Pediatric tracheostomy decisions are challenging for clinicians and parents, especially when a child’s survival/neurodevelopmental outcome is uncertain. Better understanding of parents’ values over the decision period is crucial for clinical decision-making. Objective: To describe parents’ values during tracheostomy decision-making for their critically ill child and to identify opportunities to improve parent–clinician shared decision-making (SDM). Methods: We thematically analyzed 12 semi-structured interviews with parents who recently faced a tracheostomy decision for their critically ill child. Three study team members with qualitative expertise reviewed the transcripts, identifying key topics independently. A codebook was developed, and data were coded. Key research questions guided analysis, with findings iteratively reviewed by the study team. Results: We identified parents’ values at the three time points: when the decision was introduced, during their deliberations of it, and when the ultimate decision was made. Initially, parents resisted tracheostomy because it threatens normalcy. They valued proof of a need for tracheostomy and information with certainty. As certainty for tracheostomy increased over time, parents’ hope focused on reversibility of tracheostomy and improvement in normalcy compared to current status. They concurrently worried about practical issues such as emergencies, home care, and finances. Key considerations driving the final decision included best interest of the child, perceived benefits of tracheostomy compared to its downsides or other options, and potential for better quality of life and longer life. Conclusions: Parents’ dynamic values shifting with clinical uncertainty suggests opportunities to improve SDM by attending to parents’ individualized needs and managing expectations. Full article

Introduction: Major depressive disorder (MDD) is more prevalent in women, but men with MDD may experience higher suicide risk and a different symptom profile. This study investigates the subjective impact of MDD on health-related quality of life (HR-QoL) in males and females. Methods: A cross-sectional analysis was conducted on a representative sample from six Italian regions. MDD diagnoses were determined through semi-structured clinical interviews, and HR-QoL was assessed using the SF-12 questionnaire. Mania, hypomania, and subthreshold hypomanic symptoms were evaluated using the Mood Disorder Questionnaire (MDQ). Results: Women had a higher prevalence of MDD (6.2%) than men (3.5%). However, men with MDD showed significantly lower HR-QoL scores compared to non-depressed males, with a greater difference than that observed in women. No significant sex differences emerged in psychiatric comorbidities, but men showed a trend toward higher MDQ positivity, possibly indicating a different depressive phenotype. Conclusions: Although less frequently diagnosed in men, MDD appears to have a stronger perceived impact on quality of life in males. This finding may reflect under-recognized symptoms such as irritability, hyperactivity, and social rhythm dysregulation. Gender-sensitive screening and intervention strategies are essential to improve early detection and reduce the untreated burden of depression in men, ultimately supporting more equitable mental health outcomes. Full article

Against the backdrop of growing concerns over university students’ mental health worldwide, campus environments play a crucial role not only in shaping spatial experiences but also in influencing psychological well-being. However, the psychosocial mechanisms through which campus landscapes affect well-being remain insufficiently theorized. Drawing on survey data from 500 students across two Chinese universities, this study employs structural equation modeling (SEM) and interpretable machine learning techniques (XGBoost-SHAP) to systematically examine the interrelations among landscape perception, place attachment, perceived social acceptance, school belonging, and psychological well-being. The results reveal the following: (1) campus landscapes serve as the primary catalyst for fostering emotional identification (place attachment) and social connectedness (perceived social acceptance and school belonging), thereby indirectly influencing psychological well-being through these psychosocial pathways; (2) landscape perception emerges as the strongest predictor of well-being, followed by school belonging. Although behavioral variables such as the green space maintenance quality, visit frequency, and duration of stay contribute consistently, their predictive power remains comparatively limited; (3) significant nonlinear associations are observed between core variables and well-being. While the positive effects of landscape perception, place attachment, and school belonging exhibit diminishing returns beyond certain thresholds, high levels of perceived social acceptance continue to generate sustained improvements in well-being. This study advances environmental psychology by highlighting the central role of campus landscapes in promoting mental health and provides actionable strategies for campus planning. It advocates for the design of balanced, diverse, and socially engaging landscape environments to maximize psychological benefits. Full article

Spinal cord injury (SCI) profoundly affects motor–sensory functions, reducing mobility and quality of life. Robotic exoskeletons offer a promising solution to support gait training, improve mobility, and prevent secondary complications. Existing research predominantly focuses on complete SCI, with limited exploration of long-term effects and tailored training for incomplete SCI. This study investigates device-based outcomes of personalized exoskeleton gait training in 33 individuals with incomplete SCI, with different lesion levels: cervical, thoracic, and lumbar. Participants underwent up to 39 sessions of gait training with a commercially available lower limb exoskeleton. Session parameters, including duration, intensity, and modality, were tailored to each individual’s clinical needs as determined by a medical team. Analysis focused on endurance, performance on the device, and patient-reported outcomes related to walking fluidity, safety, and satisfaction. Results showed overall improvement in endurance and performance, with the most significant gains observed in participants with thoracic-level injuries. All participants reported increased perceived safety, walking fluidity, and high satisfaction with the training. These findings support the potential of personalized exoskeleton training to enhance outcomes and experiences for individuals with incomplete SCI. The difference in improvement between lesion levels highlights the need for customized approaches to address the diverse clinical conditions within this population. Full article

Introduction. Chronic pain (CP) is a multidimensional condition that exerts a considerable impact on individuals’ quality of life and presents a wide range of clinical and psychological expressions. This study sought, firstly, to identify distinct clinical profiles among individuals with CP based on clinical indicators, and secondly, to examine the differences in psychological vulnerability and pain-related coping strategies according to the clinical profiles. Methods. A total of 251 adults diagnosed with CP and residing in Spain participated in the study. Participants completed the Purpose in Life Test, the Reflective Functioning Questionnaire, the Interpersonal Needs Questionnaire, the Beck Hopelessness Scale, the Difficulties in Emotion Regulation Scale, and the Pain Coping Questionnaire. A two-step cluster analysis was performed to identify subgroups within the sample, followed by independent samples t-tests to assess psychological differences between clusters. Results. This study identified two clinical profiles among individuals with CP, distinguished by diagnostic delay, disease progression, and functional impact. Cluster 1 exhibited greater functional impairment, lower quality of life, and higher emotional distress (uncertainty, perceived burdensomeness, emotional dysregulation, and hopelessness). In contrast, Cluster 2 showed lower functional impairment, better quality of life, greater use of distraction strategies, and a higher meaning in life. Discussion. These findings suggest that both medical and psychological aspects appear to be associated with each other and may influence the perception, evolution and adaptation to CP. Full article

Among the leading etiologies of limb amputations are diabetes mellitus, alongside trauma and peripheral vascular disease conditions, whose complications are major indications for surgery, which can subsequently elicit chronic refractory postamputation pain. ‘Phantom limb pain’ (PLP) denotes pain that is perceived as occurring in an absent part of the limb following amputation. Even though it is a relatively common complication among amputees—with an estimated prevalence as high as ~80 percent—the underlying mechanisms of this puzzling condition remain poorly understood. Current theories predominantly emphasize the role of the nervous system and neuropsychopathology in the development of PLP. However, these neurocentric explanations are disputed and have not yet been translated into effective treatments or a definitive cure for the condition, nor have several notable anomalies been settled, which has prompted researchers to call for the exploration of alternative theories. The aim of this paper is to offer an alternative mechanical mechanism for explaining PLP and spontaneous phantom sensations. This work introduces a theoretical model for the mechanism of PLP, drawing on a recent study that proposed this model to explain fibromyalgia-type psychosomatic syndromes as disorders driven by overactive soft tissue myofibroblasts. The manuscript proposes a shift from purely neurocentric models of PLP to a framework where the extracellular matrix and connective tissue, specifically myofascial tissue and inflammatory myofibroblasts—which are often overlooked in research—take part in its pathogenesis. In this suggested model, surgical interventions disrupt the biomechanical stability of the fascio-musculoskeletal biotensegrity-like system, thus acting as a contributing factor in the chronic pain manifestation. The term ‘biotensegrity’ refers to the dynamic biomechanical behavior of a living system that is stabilized by compressive and tensile force elements, a characteristic quality of myofascial tissue. In this framework, abnormal extracellular matrix remodeling, driven by overactive peripheral myofibroblasts, and the concomitant mechanical effects exerted on sensory nerves embedded within the fascia and reaching the neuroma microenvironment contribute to the generation and perception of spontaneous PLP and phantom sensations. The interplay between abnormal extracellular matrix, the neuroma’s intrinsic excitability, as well as peripheral and central neurophysiological mechanisms, collectively provide a biophysical neuropathophysiological basis to help explain PLP. This offers a different unexplored perspective on a condition with poorly understood mechanisms. Full article

This paper contributes to the field of urban waste collection systems, which are crucial for advancing sustainability, urban cleanliness, and the aesthetic quality of cities. Specifically, it introduces a novel framework designed to support planners and decision makers in the design of efficient and responsive textile waste collection systems, aligned with both environmental objectives and citizen engagement. To this end, the framework exploits a hybrid simulation platform that realistically models the logistics infrastructure in a spatially explicit environment. Also, within the framework, citizens are represented as adaptive agents whose environmental attitudes evolve through personal experience, social influence, and perceived service quality. The behavioural layer is the core element of the framework. It enables dynamic analysis of the two-way feedback between citizen participation and service effectiveness to underscore the often-overlooked role of citizen behaviour in shaping overall system performance. The model was tested in a representative urban scenario under varying operational conditions. The results highlight how policy incentives and smart collection infrastructure can significantly boost participation, while social segregation may hinder the adoption of sustainable practices. The framework ultimately offers a generalisable decision-support tool to explore the behavioural dimension of circular economy initiatives and develop robust, scenario-based strategies. Full article

To identify the impact of destination performance on long-term tourist loyalty in the context of sustainable cultural heritage tourism, this study formulated a research model to examine the relationship between destination performance and perceived value, expectation confirmation, satisfaction, and loyalty through extending the expectation–confirmation model (ECM). Using the Pantang Wuyue Historic District in Guangzhou as a case, data were collected from 542 tourists and analyzed using a structural equation model (SEM). The results indicate that destination performance exerts a direct and significant influence on long-term tourist loyalty. Furthermore, destination performance exerts a direct and significant influence on expectation confirmation and perceived value. The empirical analysis not only provides a comprehensive theoretical framework for understanding tourists’ long-term loyalty in the context of sustainable cultural heritage tourism but also offers practical insights for managers aiming to improve the quality and attractiveness of destination performance to foster long-term tourist loyalty. Full article

As mental health issues such as stress, anxiety, and depression become increasingly prevalent in urban populations, there is a critical need to embed restorative functions into the built environment. Urban parks, as integral components of ecological infrastructure, play a vital role in promoting psychological well-being. This study explores how diverse park environments facilitate mental health recovery through multi-sensory engagement, using integrated psychophysiological assessments in a wetland park in Zhengzhou, China. Electroencephalography (EEG) and perceived restoration scores were employed to evaluate recovery outcomes across four environmental types: waterfront, wetland, forest, and plaza. Key perceptual factors—including landscape design, spatial configuration, biodiversity, and facility quality—were validated and analyzed for their roles in shaping restorative experiences. Results reveal significant variation in recovery effectiveness across environments. Waterfront areas elicited the strongest physiological responses, while plazas demonstrated lower restorative benefits. Two recovery pathways were identified: a direct, sensory-driven process and a cognitively mediated route. Biodiversity promoted physiological restoration only when mediated by perceived restorative qualities, whereas landscape and spatial attributes produced more immediate effects. Facilities supported psychological recovery mainly through cognitive appraisal. The study proposes a smart park framework that incorporates environmental sensors, adaptive lighting, real-time biofeedback systems, and interactive interfaces to enhance user engagement and monitor well-being. These technologies enable urban parks to function as intelligent, health-supportive infrastructures within the broader built environment. The findings offer evidence-based guidance for designing responsive green spaces that contribute to mental resilience, aligning with the goals of smart city development and healthy life-building environments. Full article

In the context of the rapid digitalization of higher education, proactive artificial intelligence (AI) agents embedded within multi-agent systems (MAS) offer new opportunities for personalized learning, improved quality of education, and alignment with sustainable development goals. This study aims to analyze how such AI solutions are perceived by students at Narxoz University (Kazakhstan) prior to their practical implementation. The research focuses on four key aspects: the level of student trust in AI agents, perceived educational value, concerns related to privacy and autonomy, and individual readiness to use MAS tools. The article also explores how these solutions align with the Sustainable Development Goals—specifically SDG 4 (“Quality Education”) and SDG 8 (“Decent Work and Economic Growth”)—through the development of digital competencies and more equitable access to education. Methodologically, the study combines a bibliometric literature analysis, a theoretical review of pedagogical and technological MAS concepts, and a quantitative survey (n = 150) of students. The results reveal a high level of student interest in AI agents and a general readiness to use them, although this is tempered by moderate trust and significant ethical concerns. The findings suggest that the successful integration of AI into educational environments requires a strategic approach from university leadership, including change management, trust-building, and staff development. Thus, MAS technologies are viewed not only as technical innovations but also as managerial advancements that contribute to the creation of a sustainable, human-centered digital pedagogy. Full article

Artificial Intelligence (AI) profoundly shapes adolescents’ digital experiences, presenting both developmental opportunities and risks related to privacy and psychological well-being. This study investigates first the possible generational gap between adolescents and their parents in AI use and trust, and then the associations between the Trait Emotional Intelligence (trait EI), parenting styles, perceived social support, and parental involvement on adolescents’ use and trust in AI-based technologies. Participants were 170 adolescents (aged 13–17) and 175 parents from southern Italy, who completed standardized questionnaires assessing parenting styles, Trait Emotional Intelligence (Trait EI), social support, digital literacy, and use and trust in AI. Adolescents used AI more frequently than parents, especially for school- or work-related support and were more likely to seek behavioral advice from AI. They also showed higher trust in AI data security and the quality of behavioral advice than parents. Moreover, greater trait EI and more authoritative (vs. authoritarian) parenting were associated with less frequent AI use and lower use and trust in AI. In 47 matched parent–adolescent dyads, cluster analysis identified Balanced Users (higher trait EI, authoritative parenting, stronger support, cautious AI use) and At-Risk Users (lower trait EI, authoritarian parenting, lower support, heavier and more trusting AI use) Despite no causal inferences can be drawn due to the correlational nature of the data, the results suggested the importance of considering adolescents’ trait EI and authoritative parenting practices in supporting balanced and critical digital engagement, highlighting the concept of a “digital secure base” as essential for navigating the evolving digital landscape. Full article