Guided by the lens of the situated expectancy-value theory, we investigate student and educator beliefs about the value of career and technical education (CTE) and industry-based certifications (IBCs). Amid the increasing prioritization of IBCs in state and federal college and career readiness policies, we sought to investigate how students describe their motivation for participating in CTE and IBCs, how educators interpret the value of these experiences and, in turn, shape students' beliefs, and how the broader college and career readiness sociopolitical context may shape these dynamics. Interviews and focus groups with students (n = 68), educators, and administrators (n = 58) at Texas high schools (k = 7) suggest that students highly emphasize the expectancy, intrinsic, attainment, and utility values of their CTE coursework and view IBCs as a beneficial addition, especially for their perceived utility. Educators echoed students' sentiments toward CTE but, in contrast, described truly valuable certifications as "the exception" rather than the norm. Despite this skepticism, they felt an obligation to "sugarcoat" the value of IBCs to students in order to meet college and career readiness or accountability goals. Here, we see that IBCs hold different dimensions of value for different stakeholders, such as the distinction between student-level (e.g., IBCs will help them get a better job) versus educator-level (e.g., students' receipt of IBCs improves school accountability ratings and unlocks incentive funding) utility value. This situated sugarcoating performed by educators may be a key mechanism that links educational policies with student motivation for pursuing tasks educators may not perceive to be valuable for students, like IBCs.
This study aimed to identify and characterize implementation strategies for falls prevention in long-term care (LTC) homes using natural language processing (NLP) with a focus on the Registered Nurses' Association of Ontario's (RNAO) Preventing Falls and Reducing Injury from Falls (2017) Best Practice Guideline (BPG). A retrospective quality improvement study was conducted using narrative reports submitted to RNAO MyBPSO reporting system from 63 Ontario LTC homes (2017 to 2022). Free-text data describing implementation activities were analyzed using an NLP pipeline that included text preprocessing, tokenization, and keyword extraction using Rapid Automatic Keyword Extraction (RAKE). Extracted terms were aggregated into candidate themes and further analyzed using a lexicon-informed sentiment analysis approach adapted for clinical language. Themes were iteratively refined through a structured consensus process involving multidisciplinary experts. Inter-rater agreement was assessed using Cohen's kappa. A total of 153 reports generated 235 preliminary themes, which were refined through sentiment analysis and expert consensus into 10 themes. Commonly identified strategies included falls risk assessment, fall prevention strategies, risk factors of falls, care plan development, post-fall assessments, falls tools, fall documentation, education and training, huddles, organizational policies, rounding, reflecting substantial uptake of key BPG recommendations. Sentiment analysis demonstrated predominantly neutral or positive sentiments across implementation narratives, with variability indicating differences in implementation experience. Gaps were most evident in documentation, i.e., post-fall follow-up actions and policy-level strategies, suggesting opportunities to strengthen implementation fidelity. The study identified a core set of frequently implemented falls prevention strategies in LTC settings. These findings provide actionable guidance for clinical practice by emphasizing the need to standardize risk screening and reassessment processes, strengthen post-fall evaluation and follow-up, improve documentation systems to support continuity of care, and implement ongoing, competency-based education for staff. Together, these targeted strategies can support more consistent translation of evidence-based guidelines into routine practice and enhance quality-improvement efforts in falls prevention in LTC settings.
When prospective informed consent is not feasible in time-sensitive emergencies, such as hyperacute ischemic stroke, international ethics guidance recognizes that enrollment without prior consent may be permissible. Little is known about public acceptance of emergency research without prospective consent (ERWPC) in countries lacking established pathways. To estimate public acceptance of ERWPC for hyperacute ischemic stroke, to identify factors associated with ERWPC acceptance, and to compare these factors with those associated with willingness to participate in a standard stroke randomized clinical trial (RCT) requiring prospective informed consent. This survey study was conducted in 2024 using hypothetical hyperacute stroke RCT scenarios. A commercial opt-in panel recruited adults aged 20 to 79 years residing in Japan, with equal allocation across age-by-sex strata. Participants completed survey components, including 8 conjoint scenarios with varying effectiveness, adverse event risk, and consent modality, and rated their willingness to join a standard RCT. The primary outcome was ERWPC acceptance, defined as selecting willing or rather willing to participate in at least 1 scenario in a hypothetical trial without prospective consent. The secondary outcome was willingness to participate in a standard RCT. Additional measures included conjoint utilities, value domain scores, decision style, and factors associated with both primary and secondary outcomes using multivariable logistic regression. Among 1000 respondents (mean [SD] age, 50.1 [15.6] years; 500 females [50.0%]), 605 (60.5%) accepted ERWPC in at least 1 scenario, whereas 334 (33.4%) were willing to join a standard RCT. Among those unwilling to join the standard RCT (n = 666), 295 (44.3%) accepted ERWPC. ERWPC acceptance was associated with clinical trial awareness (adjusted odds ratio [AOR], 1.64; 95% CI, 1.34-2.00; P < .001), prior research participation (AOR, 2.98; 95% CI, 1.23-7.24; P = .02), preference for higher effectiveness (AOR, 1.88; 95% CI, 1.17-3.04; P = .01), tolerance for nonstandard consent (AOR, 0.43; 95% CI, 0.31-0.60; P < .001), and lower likelihood of consistent chooser status (AOR, 0.22; 95% CI, 0.16-0.33; P < .001). In contrast, willingness to join a standard RCT was associated with arrhythmia (AOR, 2.15; 95% CI, 1.04-4.48; P = .04) and dyslipidemia (AOR, 1.79; 95% CI, 1.02-3.16; P = .04), awareness of clinical trials (AOR, 2.10; 95% CI, 1.69-2.61; P < .001), and effectiveness utility (AOR, 1.49; 95% CI, 1.01-2.14; P = .046) but not informed consent utility. In this survey study, ERWPC acceptance was substantial and associated with benefit-risk considerations and research familiarity. Differences in factors associated with ERWPC acceptance and standard RCT willingness suggest that emergency research responses cannot be attributed to general attitudes toward RCT participation.
To evaluate how a custom web application integrating clinician-edited large language model (LLM)-generated summaries, clickable definitions, and artificial intelligence (AI)-generated videos affects radiology report comprehension, feature preferences, and overall sentiment toward AI-assisted report summaries. This prospective study recruited participants between May and July 2025 at a hospital-based outpatient imaging floor before their scheduled examinations at a tertiary university hospital. Following exam completion and report publication, patient-friendly AI summaries were generated and reviewed by a radiologist for accuracy. Participants were then shown a web application containing their own de-identified, AI-augmented reports featuring clinician-edited LLM-generated summaries with clickable terms and AI videos. Participants were surveyed on comprehension, feature usefulness, and attitudes toward LLM summaries. Participants (n=101, 40 male/61 female, racially diverse) ranged from 20 to 82 (mean 58±15) years old. Overall comprehension improved significantly (median pre: 4.00, post: 5.00, p<0.001), with 47.52% (n=48) identifying LLM-summaries as most helpful. However, LLM-summaries required manual clinician edits (average per summary: 24.75 words removed; 0.13 words added, lexical similarity = 84.63%; semantic similarity = 98.25%). When asked if they were comfortable with LLM-summaries without clinician edits, most participants reported being only Somewhat comfortable (27.72%) or Very uncomfortable (25.74%). This prospective study demonstrates that interactive, LLM-driven applications can significantly improve self-reported patient comprehension of complex radiology reports, emphasizing their potential to enhance patient-centered communication. However, patients had reservations about clinician-edited LLM-generated summaries, indicating that successful integration is contingent on professional oversight - an added workload that may limit scalable real-world implementation.
Motivational interviewing (MI) is a patient-centred, goal-oriented psychotherapy for alcohol use disorder (AUD) and numerous other conditions. While some language patterns have been linked to MI response, less is known about how broader linguistic features, sentiment, and engagement relate to post-intervention drinking. This study used natural language processing to examine these associations and clarify mechanisms through which MI for AUD exerts its effects. Adults with AUD (N = 68) completed a single MI session with structured feedback and discussion of potential drinking changes. Speech transcripts were analysed for change-, emotion-, motivation-, substance-, and health-related words. Sentiment analysis assessed emotional polarity, and engagement was measured by total words spoken. Linear regression models tested associations between linguistic features and drinking outcomes, including drinks/week, percent heavy drinking days (%HDD), and percent drinking days (%DD). Participants showed significant reductions in drinks per week and %DD. Consistent with recent reviews of MI predictors, linguistic analyses found that greater use of change talk and health-related language was associated with more drinks per week at follow-up, whereas greater emotional talk and positive sentiment predicted fewer drinks per week. Health- and substance-related language predicted higher %HDD, while social motivation-related language predicted lower %DD. Term-frequency and multivariate analyses supported these patterns. Via natural language processing of MI speech, linguistic features such as motivational content and sentiment were linked to drinking outcomes. Findings demonstrate the potential of this approach as a scalable, data-driven complement to traditional coding systems, with applications for real-time feedback, clinician training, and personalized interventions.
Tobacco litter is one of the most common forms of litter, comprising between 26 and 33% of all visible litter, leading to severe environmental damage. The current study attempts to assess the compliance with the Tobacco-Free Kumbh Mela (TFKM) mandate by analyzing the spatial distribution of tobacco product wastes (TPWs) in Haridwar, Uttarakhand, during mid-March and April 2021. We collected information about TPWs (smoking and smokeless tobacco) in the Kumbh Mela area during the busiest week. The litter count (mean ± S.D.) was calculated for total TPWs along with litter density (per sqm) in various public places. We also used Quantum Geographic Information System (QGIS) software to develop a graduated map of the density of TPWs across the Kumbh Mela area. Bathing areas at the TFKM, which had the largest population density, had the least litter count (4.33 ± 1.26) and density (0.9 per sqm). While in the remotest location, parking areas were found to have maximum litter count (30.0 ± 18.0) and density (6.5 per sqm). Overall, the surveyed sites were non-compliant with the Tobacco-free Kumbh Mela as notified by the state government. Mass awareness campaigns should be undertaken at large scale to educate tobacco users regarding the harmful effects of tobacco use and the TPWs while inculcating a pro-envirnoment attitude to ensure compliance with directives like TFKM.
Teledentistry has emerged as a promising digital health strategy; however, its implementation depends largely on clinicians' preparedness. This study assessed the knowledge, attitudes, and practices (KAP) of dentists in Erbil City, Iraq, toward teledentistry and identified factors associated with its adoption. A cross-sectional survey was conducted among 426 licensed dentists. KAP levels were classified using modified Bloom's cut-off criteria, and multivariable logistic regression analyses were performed to identify independent predictors of good knowledge, positive attitude, and good practice. Overall, poor knowledge was observed in 62.9% of participants, moderate knowledge in 9.2%, and high knowledge in 27.9%. Attitudes were predominantly neutral (49.1%), while only 8.7% demonstrated positive attitudes. Poor practice was reported by 63.1%, and only 16.2% showed good teledentistry practice. Knowledge level was significantly associated with professional qualification (p < 0.001), while positive attitude was associated with female gender (AOR = 2.65, 95% CI: 1.08-6.52, p = 0.034) and good knowledge (AOR = 7.17, 95% CI: 3.28-15.66, p < 0.001). Good practice was significantly associated with good knowledge (AOR = 23.29, 95% CI: 10.70-50.70, p < 0.001) and increasing age (AOR = 1.12 per year, 95% CI: 1.07-1.17, p < 0.001). The most frequently reported barriers were concerns regarding patient acceptance (84.7%) and lack of formal training (83.8%). These findings likely reflect perceived rather than objectively measured barriers and may be influenced by limited clinical experience with teledentistry. Teledentistry adoption among dentists in Erbil remains limited and appears primarily constrained by gaps in knowledge and practical competence rather than negative perceptions alone.
Given the limited evidence on the awareness and attitudes of health professionals who educate pregnant women about endocrine disruptors, alongside growing concern regarding their adverse effects during pregnancy, this study was conducted to assess these factors. The study, which was carried out according to cross-sectional, descriptive, and correlational methods, was implemented during an antenatal education conference held in Izmir between October 27-30, 2023. The sample consisted of 178 health professionals, including midwives, nurses, and obstetricians, who attended the congress and provided education to pregnant women. Data were collected with the Introductory Information Form (IIF), Endocrine Disruptors Attitude Scale (EDAS), and Endocrine Disruptor Chemicals Awareness Scale for Health Professionals (EDCAS). A total of 83.7% of the participants had not received training on endocrine disruptors. The mean EDAS score of the participants was 80.87±11.39, and the mean EDCAS score was 84.93±13.34. There is a weak correlation between the EDCAS score and the EDAS score and a moderately significant relationship between the general awareness sub-dimension of EDCAS and EDAS (p < 0.05). Participants who received training on endocrine disruptors had higher EDCAS and EDAS scores (p < 0.01). These findings are relevant to perinatal health as they show that many prenatal health professionals lack formal training despite moderate awareness and positive attitudes. Since training is associated with higher awareness and attitudes, improving education may enhance counseling, reduce harmful exposures, and support better maternal and fetal outcomes.
BackgroundPre-exposure prophylaxis (PrEP) is highly effective in preventing human immunodeficiency virus (HIV) transmission, particularly for individuals at increased risk. However, uptake and long-term adherence remain challenging, with limited data on pharmacies beyond pilot studies. This study explored how psychological, social, and structural factors shape perceptions of HIV risk and influence PrEP adherence, using the Tripartite Risk Perception (TRIRISK) model, Protection Motivation Theory, and the Theory of Planned Behavior.MethodsA qualitative design using in-depth interviews (IDIs) was conducted pre-implementation (May 2023) and during implementation (April-July 2024) of pharmacy-based PrEP services. Participants were adults (18+years) accessing pharmacy-based PrEP services in Gauteng and the Western Cape, South Africa. Data were analyzed thematically using Excel and MAXQDA, guided by the integrated behavioral frameworks.ResultsA total of 99 IDIs were conducted, 30 in 2023, 69 in 2024. Through the TRIRISK model, this study found that decisions to start or continue PrEP were shaped by perceived vulnerability to HIV, awareness of risky sexual behaviors, mistrust of partners, and emotional experiences like fear and trauma. The PMT further highlighted how emotional triggers, along with perceived severity and coping efficacy, affected motivation to initiate or continue PrEP. The TPB helped explain how subjective norms, such as stigma and social judgment, and perceived behavioral control, shaped by access, convenience, and privacy, impacted adherence.ConclusionIntegrated behavioral frameworks offer critical insights into PrEP-related decision making. Interventions, including pharmacy-based PrEP models, should address emotional barriers, such as stigma-sensitive messaging, strengthening social support, and reducing structural inequalities. HIV Risk Perception and PrEP UsePre-exposure prophylaxis (PrEP) is a highly effective medicine that helps prevent human immunodeficiency virus (HIV). However, not everyone who needs PrEP uses it effectively. In South Africa, PrEP is being offered in some pharmacies to make it easier to access compared to most public clinic settings. This study looked at what people think and feel about their risk of getting HIV, and how those thoughts shape their decision to take PrEP. We interviewed 2 groups of pharmacy clients at different stages of implementation: one group before pharmacy-based PrEP was rolled out, and another group during implementation after PrEP had been initiated. We used 3 behavioral theories to understand how people assess their risk and make decisions about PrEP use. We found that people were more likely to start PrEP when they felt personally at risk of HIV, for example due to a partner's unfaithfulness or past traumatic experiences. Support from peers, privacy at the pharmacy, and easy access made it easier to keep using PrEP. However, stigma, travel, and life challenges like family responsibilities often made it harder to continue. This study shows that providing PrEP through pharmacies can work well, but emotional, social, and structural barriers must be addressed. PrEP programs should include supportive messaging, flexible access options, and tools that help people stay on PrEP even when life gets difficult.
Post-stroke depression (PSD) significantly affects stroke recovery, and caregivers play a crucial role in managing this condition. However, little is known about caregivers' knowledge, attitude, and practice (KAP) regarding PSD in China. This study aims to evaluate the KAP of caregivers of stroke patients concerning PSD and identify factors influencing these dimensions. A cross-sectional study was conducted at the China Rehabilitation Research Center, Beijing. A total of 497 valid questionnaires, covering demographic information, knowledge, attitude, and practice related to PSD, were collected from caregivers of stroke patients. Statistical analysis included descriptive statistics, logistic regression, and structural equation modeling (SEM). The mean age of caregivers was 42.65 ± 13.97 years, with the majority being women (62.98%) and married (81.49%). The average knowledge score was 18.37 ± 9.77 (57.4% of the maximum score), indicating insufficient knowledge. The scores of attitude and practice were 33.17 ± 3.89 (82.92%) and 22.51 ± 3.13 (90.04%), respectively, indicating a positive attitude and favorable practice. Significant differences were found in knowledge based on gender, education, income, stroke duration, and whether patients had undergone depression screening. Knowledge was positively associated with attitude (OR = 1.11, 95% CI: 1.08-1.15, p < 0.001) and practice (OR = 1.07, 95% CI: 1.02-1.12, p = 0.006). SEM analysis revealed positive associations between knowledge, attitude, and practice (all p < 0.001), with knowledge and attitude influencing practice. Caregivers exhibited insufficient knowledge about PSD, particularly regarding the recognition of PSD symptoms, its potential severity (e.g., association with self-harm or suicidal tendencies), and appropriate management strategies, but displayed positive attitudes and practices. Factors like stroke duration, depression screening, and caregiver education significantly influenced these dimensions. These knowledge gaps may limit caregivers' ability to identify and respond appropriately to PSD, despite their generally positive attitudes and practices. The findings suggest the need for targeted and structured educational interventions to improve caregivers' ability to recognize and manage PSD, which may ultimately enhance patient outcomes and caregiving quality.
This study aimed to evaluate Polish women's attitudes toward water birth, including perceived benefits, concerns, and the influence of demographic factors such as age, education, residence, and childbirth history. A cross-sectional online survey was conducted using a structured questionnaire shared in 76 Facebook groups targeting women and families in Poland. Responses were collected from February 17 to July 27, 2025. The questionnaire included demographic questions, childbirth history, awareness of water birth, perceived pros and cons, sources of information, and willingness to consider this method. Statistical analysis included descriptive statistics and Pearson's chi-squared test. A total of 1,376 responses were analyzed. Awareness of water birth was high (98.2%), mainly acquired via the internet (83.6%). Benefits were known by 70.6% of respondents, particularly those aged 35-44 and those with higher education (p < 0.001). The most cited benefits were pain reduction (59.9%) and relaxation (51.6%). The most common concerns included complications (25.8%) and lack of familiarity (17.9%). Women with prior water birth experience were highly likely to choose it again (96.7%). Overall, 74.0% of all respondents would consider water birth, and 82.8% expressed a need for more accessible educational materials. Polish women are generally aware of and open to water birth, but many lack access or adequate knowledge. Misinformation and limited awareness of contraindications persist, especially among younger and less-educated women. Educational efforts should be enhanced, particularly online, to support informed childbirth choices.
Interprofessional education (IPE) prepares healthcare professionals (HCP) for interprofessional collaborative practice (IPCP) by fostering knowledge, skills, values, and attitudes. Attitudes trigger approach or avoidance motivation, making engagement with IPCP more likely when HCPs hold positive attitudes. As research has struggled to consistently demonstrate a positive, long-term impact of IPE on healthcare students' attitudes, we investigated attitude development longitudinally in three undergraduate cohorts studying to become dieticians, midwives, nurses, or physiotherapists at a university of applied sciences in Switzerland. Specifically, we examined (1) whether related interprofessional attitude dimensions influenced each other over time, (2) how stable these dimensions were, (3) the impact of student characteristics, and (4) whether attitudes improved across time. We conducted a longitudinal study using structural equation modeling (SEM) to estimate cross-lagged panel models (CLPM) based on two out of three dimensions of the German version of the Interprofessional Attitudes Scale (G-IPAS): Teamwork, Roles, Responsibilities (TRR) and Community-Centeredness (CC). Of 879 undergraduate students who began their studies between 2018 and 2021, 234 provided data at least twice and were included in the final analyses. No cross-lagged effects were found between TRR and CC, however they showed moderate to moderate-to-strong stability across time. Student characteristics influenced attitudes: semester of study was positively associated with CC, male sex was negatively associated with CC, dietetics students reported more positive CC attitudes, and physiotherapy students reported more negative TRR attitudes. TRR attitude scores decreased significantly over time, while a change in CC could not be verified due to inadequate model fit. IPE did not produce the expected positive effect on interprofessional attitude development during undergraduate healthcare studies, in contrast to much previous research. The absence of reciprocal effects between attitude dimensions across time may indicate that they are serving different underlying psychological functions, with TRR being more utilitarian and CC being more value-oriented. Tailoring IPE curricula to the underlying psychological functions that interprofessional attitudes serve in different learner groups may enhance their effectiveness, thereby fostering positive and durable attitudinal change.
Antimicrobial resistance (AMR) is a growing One Health challenge in low- and middle-income countries, where inappropriate antimicrobial use across human and animal sectors remains common. In Ethiopia, national AMR strategies and One Health frameworks exist, but evidence remains limited on how knowledge, attitudes, and practices shape antimicrobial-use behaviors across community and animal health settings. We conducted a convergent parallel mixed-methods study from June to November 2024 in Addis Ababa, Oromia, and Afar, Ethiopia. Quantitative data were collected using structured knowledge, attitude, and practice surveys among household respondents (n = 750) and animal health professionals (n = 251). Knowledge was defined as factual understanding of antimicrobials and AMR; attitude as beliefs, perceived risk, and stewardship orientation; and practice as self-reported antimicrobial-use and stewardship-related behaviors. Composite KAP scores were standardized from 0 to 1, with higher scores indicating better outcomes. Fractional logit regression was used to assess factors associated with AMR-related practice scores. Qualitative data were collected through 24 focus group discussions, 58 key informant interviews, and 34 in-depth interviews, and analyzed thematically to contextualize quantitative findings. Households had moderate knowledge (mean = 0.62) and positive attitudes (mean = 0.75) but suboptimal practices (mean = 0.58). Animal health professionals had higher knowledge (mean = 0.88) and attitudes (mean = 0.79), but lower practice scores (mean = 0.49). Attitude was the most consistent factor associated with better AMR-related practices among both households (aOR = 1.26; 95% CI: 1.17-1.36) and animal health professionals (aOR = 1.50; 95% CI: 1.28-1.75). Knowledge was significantly associated with practice only among animal health professionals. Larger household size was negatively associated with household practice, while professional affiliation was associated with animal health professional practice. Qualitative findings showed that financial constraints, non-prescription antimicrobial access, limited diagnostic capacity, weak enforcement, and client pressure constrained the translation of knowledge and positive attitudes into appropriate practice. AMR-related practices in Ethiopia are shaped by attitudes, professional and household contexts, and structural constraints, rather than knowledge alone. Interventions should move beyond information provision to address risk perception, social norms, affordability, diagnostic access, regulatory enforcement, and stewardship support. Strengthened One Health coordination across human and animal sectors is essential to translate Ethiopia's AMR policies into effective practice.
BackgroundInfertility affects 1 in 6 couples, with significant variations in awareness and acceptance of fertility treatments worldwide.ObjectivesThis study aimed to evaluate the awareness, knowledge and attitude on fertility treatments among the reproductive-age population in Hong Kong.DesignThis was a cross-sectional questionnaire study.MethodsThe questionnaires were distributed to individuals at the public area of the Obstetrics and Gynaecology clinic.ResultsOf the 506 subjects recruited, 497 (98.2%) responded. While 65% demonstrated awareness of reproductive treatments, only half understood infertility's definition and prevalence. Univariate logistic regression identified older age (OR 1.08, p<0.001) and better education level (OR 1.87, p=0.004) as significant predictors of awareness. Acceptance was reported by 70% of respondents, particularly among those with better knowledge and no religious beliefs.ConclusionThe findings underscore gaps in public awareness and knowledge on fertility treatments. It highlights the need for targeted education campaigns and policy enhancements to improve acceptability and accessibility.
Research evidence indicates that good knowledge, positive attitudes, and regular contraceptive use are linked to a reduction in unintended pregnancies among adolescents worldwide. Despite the high rate of unintended pregnancies in Ghana, particularly in the Volta Region, there is limited information about adolescents' knowledge, attitudes, and contraceptive practices. This study examined the knowledge, attitudes, and contraceptive use among adolescents in the Ho Municipality of Ghana. This study used a quantitative cross-sectional design, with a convenience sampling method to recruit 841 adolescents in the Ho Municipality. The primary outcome variable was contraceptive use, and the secondary outcome variables-knowledge of and attitude towards contraceptive use-were measured with standardised scales with Cronbach's α reported above the cutoff of 0.7 (contraceptive use: α = 86; Knowledge: α = 0.93; Attitude: α = 0.95). All tests were done using a 5% level of significance in the R statistical package and the SPSS software version 27. This study found that the prevalence of contraceptive use was comparatively low (48.2%). The multiple logistic regression model indicated that employed participants (aOR = 3.98, 95% CI = 1.51, 11.62, p = 0.007) and older adolescents (aOR=1.44, 95% CI = 1.23, 1.69, p < 0.001) were more likely to use contraceptives compared to their counterparts. Additionally, the analysis showed that adolescents with no formal education (aOR = 4.95, 95% CI = 1.65, 18.56, p = 0.008) were more likely to have positive attitudes than those with tertiary education. The results also revealed that adolescents aged 18 and above (aOR = 4.09, 95% CI = 2.21, 7.66, p < 0.001), those who were employed (aOR = 3.26, 95% CI = 1.32, 8.65, p = 0.013), and those with one child (aOR = 6.29, 95% CI = 1.03, 43.73, p = 0.049) were more likely to have good knowledge compared to their counterparts. The rate of contraceptive use among the participants was low. Socio-demographic factors such as education, employment status, and age contribute to unequal outcomes in attitude, knowledge, and contraceptive use among adolescents. Health interventions aimed at addressing inequalities in attitudes, knowledge, and contraceptive use among adolescents in the study setting should target socio-demographic factors.
This cross-sectional study, conducted January 15-June 30, 2025 at Jilin Province FAW General Hospital, assessed the knowledge, attitudes, and practices (KAP) of postoperative patients regarding postoperative fatigue syndrome (POFS), a multifactorial condition characterized by persistent fatigue, reduced energy, and functional impairment following surgery that cannot be relieved by rest. Among 310 valid responses, knowledge scored a median of 3 out of 20, while attitude and practice medians were 36/45 and 32/45 respectively. Multivariate linear regression identified knowledge (β = 0.348, 95% CI 0.225-0.470, P < 0.001), attitude (β = 0.491, 95% CI 0.350-0.632, P < 0.001), monthly per capita household income of 5,000-20,000 yuan (β = 2.485, 95% CI 1.210-5.107, P = 0.013), and presence of POFS (β = 1.831, 95% CI 0.684-2.979, P = 0.002) as independent factors associated with practice scores. Structural equation modeling suggested potential direct effects of knowledge (β = 0.290, P = 0.009) and attitude (β = 0.361, P = 0.003) on practice. The findings suggest overall poor POFS knowledge, relatively positive attitudes, and suboptimal self-management practices, underscoring the need for targeted patient education to improve recovery outcomes and reduce systemic healthcare burden.
Background Clear, accurate, and empathetic communication is essential in pediatric anesthesia, where parental anxiety and information needs are high. Traditional patient information leaflets (PILs), while clinically robust, may lack emotional engagement. Large language model (LLM)-based chatbots, such as ChatGPT and Google Gemini, offer a novel, interactive approach to patient education, yet their role in pediatric anesthesia remains inadequately explored. Objective To evaluate and compare the readability, accuracy, completeness, sentiment, and parental satisfaction of artificial intelligence (AI)-generated patient education materials (ChatGPT and Google Gemini) with a clinician-authored departmental PIL (DPIL) for pediatric general anesthesia.  Methods This pilot cross-sectional study evaluated responses generated by ChatGPT and Google Gemini to seven frequently asked questions derived from the departmental PIL. Three blinded leaflets were presented in randomized order using a computer-generated sequence and evaluated by 10 anesthetists for accuracy and completeness using 10-point Likert scales. Readability was assessed using Flesch Reading Ease and Flesch-Kincaid Grade Level scores. Sentiment analysis and parental satisfaction were also assessed. Both descriptive and inferential statistical analyses were performed.  Results The DPIL demonstrated the highest readability, followed by ChatGPT, with Gemini scoring the lowest. All materials exceeded the recommended sixth-grade readability level. No significant differences were observed in accuracy or completeness among the three sources (p > 0.05). Parents consistently perceived ChatGPT responses as more reassuring and relatable, while the DPIL was viewed as informative but formal. Gemini responses were often considered linguistically complex. ChatGPT demonstrated a neutral and more empathetic sentiment compared with the other leaflets. Conclusion Clinician-authored PILS remain the most reliable source of pediatric anesthesia information. AI-generated content, particularly ChatGPT, may enhance clarity and emotional reassurance when used as a clinician-reviewed adjunct rather than a replacement.
Effective inhalation therapy is critical for managing chronic airway diseases, yet improper technique remains prevalent and contributes to poor clinical outcomes. In China, nurses play a central role in patient education. However, the relationship between nurses' own training and their competency in delivering inhalation therapy education remains underexplored. A cross-sectional online survey was conducted from September to October 2025 among 387 respiratory nurses from 32 hospitals across 25 provinces. A validated 61-item questionnaire assessed their knowledge, attitudes, practices (KAP), and training status regarding inhalation therapy. Mean scores were 33.78 ± 2.76 for knowledge, 35.01 ± 7.98 for attitude, and 61.37 ± 10.2 for practice. Only 50.13% achieved a "good" level of theoretical knowledge. Practice correlated more with attitudes (Rho = 0.57, P < 0.001) than knowledge. Years of experience in specialty nursing, practical workshops and specialist nurse training were markedly associated with the knowledge and practice of inhalation therapy, respectively (P < 0.05), while educational video utilization was significantly correlated with better performance in both areas (all P < 0.05). In summary, respiratory nurses demonstrate positive attitudes and practices but have insufficient theoretical knowledge towards inhalation therapy. Integrated learning strategies combining theoretical instruction with visual tools like educational videos are recommended.
Effective patient education is essential in neurosurgery, but many materials exceed recommended readability levels, which can limit comprehension and informed consent. Simplification can also alter tone, potentially introducing bias. Recent studies have used large language models such as Chat Generative Pre-trained Transformer (ChatGPT) to simplify neurosurgical patient education materials (PEMs), but the impact of this process on sentiment and emotional tone remains unclear. Our objective was to assess the sentiment and emotional tone of neurosurgical PEMs before and after conversion to a lower reading level by ChatGPT. A total of 336 neurosurgical PEMs covering stroke, spinal stenosis, hydrocephalus, epilepsy, and pituitary brain tumors were analyzed for readability, sentiment, and emotion. Each was then simplified to a seventh grade level using GPT-4.0. Readability was evaluated using Flesch-Kincaid Grade, Flesch Reading Ease, Gunning Fog Index, Automated Readability Index, Coleman-Liau Index, and Simple Measure of Gobbledygook. Sentiment and emotional tone were described using the Valence Aware Dictionary and sEntiment Reasoner (VADER) algorithm and National Research Council Canada Emotion Lexicon. Paired statistical t-tests assessed the significance of changes. Simplification produced substantial improvements in readability across all 6 indices and all neurosurgical topics (P < .001). Sentiment shifted toward increased positivity, reflected by higher VADER compound scores, more positive tokens, and fewer neutral tokens. Disgust decreased significantly across every topic, whereas sadness, surprise, and joy increased modestly; fear and anger showed no significant change. Topic-level analyses mirrored global patterns, demonstrating consistent directional effects. Overall, simplification achieved large readability gains while introducing small but measurable alterations in emotional tone. The decrease in neutral and negative sentiment suggests a shift toward more persuasive language. Modest but consistent shifts in sentiment and emotional tone accompanying artificial intelligence-assisted simplification highlight the potential for unintended affective shifts during artificial intelligence simplification and warrant monitoring when deploying large language models for patient-facing materials. Current PEMs pose a communication barrier between patient and provider, but providers must be careful.
To examine whether Indigenous Peoples' and Local Communities' (IPLC) ontologies are associated with knowledge, attitudes and practices (KAP) related to wildlife cohabitation and zoonotic disease transmission in biodiversity-rich areas of Latin America. Cross-sectional household survey using a standardised KAP questionnaire. Ontologies were classified using latent class analysis. Associations between ontology classes and outcomes were assessed using multivariable logistic regression models. Urban, rural and protected areas in biodiversity-rich regions of Bolivia, Brazil, Chile and Guatemala. A total of 2903 individuals aged ≥10 years were recruited through random household sampling (response rate 85%). Primary outcomes were defined according to the KAP framework. Knowledge outcomes comprised combined knowledge of zoonotic disease transmission from wildlife to humans and knowledge of zoonotic risks associated with wildlife trade. Perceived training needs related to zoonotic disease prevention were analysed as a secondary knowledge outcome measure. Attitudes were measured through risk perception, operationalised as concern about zoonotic disease transmission. Practices included self-reported hunting and slaughtering of wildlife. The analysis identified three distinct ontology classes: Relational environmentalism (52% of the population), characterised by strong spiritual connections to animals and a tendency to protect wildlife; Dualistic environmentalism (28%), with a weaker spiritual connection to animals but a commitment to wildlife conservation; and Neutral (20%), demonstrating little spiritual connection to animals and a neutral attitude towards wildlife conservation. In the logistic regression analyses, both environmentalism groups exhibited greater knowledge of zoonotic transmission and concern about outbreaks, with members of the Relational class demonstrating higher levels of these attributes. Furthermore, members of the Dualistic environmentalism class were less likely to have close contact with animals. In Latin America's biodiversity-rich regions, individuals whose ontology aligns with environmentalism appear to demonstrate a heightened awareness of zoonoses, particularly those who adhere to a Relational environmentalism perspective. Consequently, the integration of IPLC cultural knowledge holds potential to enhance wildlife conservation measures and contribute to the mitigation of disease transmission. Further research is needed to explore causal pathways and the integration of culturally grounded approaches into public health interventions.