Outcome Expectations Research Articles

High Preoperative Expectations may not Need to be Feared.

Retrospective. Evaluate correlations between preoperative expectations for pain improvement and 12-month functional outcomes and satisfaction following 1-2 level primary anterior cervical surgery. Limited data exists evaluating correlations between patients' preoperative expectations for pain relief and subsequent functional and satisfaction outcomes following primary anterior cervical surgery. Understanding correlations between expectations and outcomes may help identify patients most likely to benefit from surgery. Patients who underwent 1-2 level primary ACDF or CDA for degenerative disease between 2016-2021 were included. All patients had 12-month NDI data. Preoperative expectations for pain relief were collected at the initial clinic visit using 5-point Likert scales. Preoperative and 12-month postoperative satisfaction were recorded using 7-point Likert scales. Covariates including age, gender, procedure type, smoking status, opioid use, worker's compensation/litigation, BMI, and indication (radiculopathy versus myelopathy). Linear regression models were constructed to assess 12-month NDI change score versus pain relief expectations. Additional regression models assessed expectations versus achievement of MCID at 3- and 12-months and satisfaction at 12-months. 198 ACDF (56.1% female, median age 57) and 52 CDR patients (55.8% female, median age 51) were included. Regression models found no significant correlations between pain relief expectations and degree of NDI score improvement at the 12-month postoperative timepoint or MCID achievement at the 3- and 12-month postoperative timepoints. There was no association between preoperative expectations and 12-month satisfaction. However, greater preoperative dissatisfaction was significantly associated with greater 12-month improvement in NDI score. Preoperative pain relief expectations were not associated with functional outcomes or satisfaction following 1-2 level primary ACDF or CDR at 12-month follow-up. Patients' dissatisfaction with their preoperative spinal condition was significantly associated with greater 12-month NDI improvement. Assessing preoperative satisfaction may help identify those most likely to benefit from surgery.

Development and Validation of the Career Authenticity Scale (CAS).

The self is crucial in career development, and authenticity emerges when individuals live in accordance with their true selves. This true self includes a deep awareness of one's abilities, cognitive, physical, and emotional traits, and unbiased answers to "Who am I?". Given its importance in career development, originality can significantly impact one's professional journey. This study brings a new structure to the field of career counseling with the term career authenticity. Career authenticity is a condition that emerges when individuals manage external influences and make their career choices in accordance with their true selves, thus achieving a work life that contributes to the meaning and purpose of their lives. The Career Authenticity Scale (CAS) was developed and validated in two samples of university students. In Study 1 (n = 402), the CAS was developed, and a structure consisting of 12 items and three dimensions was obtained as a result of exploratory factor analysis. Calculations also included the internal reliability coefficients of the CAS. In Study 2 (n = 322), the structure confirming the factors obtained in the first study was confirmed. Analyses also included convergent and discriminant validity, criterion-related validity, measurement invariance across gender, and item discrimination power of the CAS. The results show that the CAS meets the conditions for convergent and discriminant validity. A positive relationship was detected between the CAS and vocational outcome expectations and career proactive behaviors. The CAS was found to provide measurement invariance at configural, metric, scalar and strict invariance levels according to gender. In conclusion, the CAS was proven to be a valid and reliable measurement tool.

Outcome expectations, self-efficacy, eating environment, and eating behaviors by the stages of change in adequate sodium intake among university students: a cross-sectional study

Objectives: This study investigated whether outcome expectations, self-efficacy, eating environment, and eating behaviors differed according to the stages of change in adequate sodium intake among university students. Methods: The participants were students recruited from nine universities in Seoul, Korea. An online survey was conducted, and data from 351 participants were analyzed. Participants were classified into pre-action and action stages based on adequate sodium intake. Data were analyzed using t-test, χ2-test, analysis of covariance, and correlation analysis. Results: Participants in the action stage (22.8%) felt fewer disadvantages of eating sodium adequately compared to those in the pre-action stage (77.2%, P < 0.001) and perceived more self-efficacy for healthy eating behaviors (P < 0.001) and controlling sodium intake (P < 0.01). The participants in the action stage also showed more desirable eating behaviors than those in the pre-action stage, including general eating behaviors, behaviors related to sodium intake, and sodium checks (P < 0.001). The physical environment in the action stage was more supportive of adequate sodium intake (P < 0.05). Eating behaviors, self-efficacy, and outcome expectations were significantly correlated with the stages of change; however, some differences were noticed in the correlation of the subscales of variables with the stages of change when examined by sex. Conclusion: We observed differences in factors according to the stages of change in adequate sodium intake. For the pre-action stage, nutrition education can be planned to modify negative expectations of eating adequate sodium, foster self-efficacy, and practice general eating behaviors and behaviors to gradually reduce sodium intake. It is also necessary to alter the physical environment to reduce sodium intake. In the action stage, support and reinforcement are needed to continually practice and maintain desirable eating behaviors. Nutrition education for women may be planned using multiple paths, whereas a simple strategy may be useful for men.

Tools for effective patient education to manage outcome expectations in paediatric facial reanimation: a systematic review

Aim: Informed consent for paediatric facial reanimation requires effective patient/parent education and involvement in a shared decision-making (SDM) process to help set their expectations and understanding from the outset. No article in the current literature has systematically reviewed the available tools for facilitating effective patient/parent education and the validity of informed consent in the context of paediatric facial reanimation. Methods: A systematic literature review was undertaken, following the Preferred Reporting Items of Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. MEDLINE via PubMed, Embase and Cochrane Library were searched and the results screened and reviewed in accordance with pre-defined inclusion and exclusion criteria. Results: The initial search yielded 478 articles, of which only 4 fulfilled the study’s inclusion criteria. One cohort study evaluated qualitative feedback from patients and their relatives participating in a family education and support day for paediatric facial palsy, while another article from the same group reviewed the readability of online education resources. The remaining two articles represented educational reviews focusing on treatment and patient education based on expert opinion without providing original outcome data. Conclusion: There is a paucity of evidence regarding patient/parent education to support the informed consent process for children undergoing paediatric facial reanimation. There remains a need for further resources and platforms to be developed that may support children and their parents in engaging in a SDM process, setting appropriate expectations, and providing valid informed consent for their surgery.

Enhancing stroke awareness in schools: efficacy of the HOBIT program in Czechia’s disadvantaged areas

Abstract Background For stroke treatment to be effective, it must be given as soon as possible. Delays are often caused by stroke bystanders failing to recognize symptoms and activate emergency medical services (EMS). This is especially a problem in socially excluded localities. This study evaluated the efficacy of a school-based intervention (HOBIT) in improving determinants and behavior intentions of EMS activation for suspected stroke in Czech socially excluded localities. Methods The quasi-experiment was conducted from May to June 2023 in the Moravian-Silesian region, Czechia. Schools were allocated to the intervention or control group (1:1). The HOBIT is a school-based intervention used to change health-seeking behavior when stroke is suspected. The primary outcome was the percentage change from the pretest to the follow-up test in the intervention group compared to the control group. The primary outcome was assessed in 4 domains: 1) knowledge, 2) behavioral intentions, 3) self-efficacy, and 4) outcome expectations. The intervention and control groups were compared using an unpaired t-test. Results We recruited 138 students aged 10-16 from 4 schools. The absolute differences in improvement between the control and intervention groups were 18% (95% CI 9-26, P < 0.001) for knowledge, 15% (95% CI 2-26, P = 0.01) for behavioral intentions, 6% (95% CI -4-15, P = 0.24) for self-efficacy, and 13% (95% CI 5-21, P < 0.001) for outcome expectations. The subgroup analysis showed that the intervention effect on self-efficacy, outcome expectations, and stroke behavior intentions was significant only in females. Conclusions The HOBIT improved stroke determinants and behavior intentions of EMS activation at schools in socially excluded areas. This study presents a health promotion practice that has the potential to improve stroke outcomes on a community level. It underscores the potential of school settings as an appropriate way to reduce health inequalities in socially excluded communities. Key messages • The HOBIT intervention improved determinants and behavior intentions of EMS activation for suspected stroke among students in socially excluded localities. • The study underscores the potential of school settings in reducing health inequalities and improving stroke-related outcomes in socially excluded localities.

Novice clinician educator professional identity formation through a longitudinal mentorship: a qualitative study

BackgroundThe professional identity of doctors is evolving with physicians now required to be ‘scholars’, facilitating the education of students and healthcare teammates as educators. Mentoring is widely practiced and is postulated to facilitate professional identity formation (PIF) through socialization.Preliminary literature review suggested few studies looking into how formal mentoring programmes affect PIF of novice clinician educators, particularly an Asian context. I hope to understand the perceived professional identity of such educators, and what changes in professional identity are observed after longitudinal mentorship, using the social cognitive career theory (SCCT) as an underpinning framework.MethodsA qualitative study explored perspectives of mentees with less than two years teaching experience and participating in a formal mentoring programme. Semi-structured interviews were conducted at the beginning and end of the programme. Thematic analysis and coding of these taped and transcribed interviews was performed and triangulated with an elite interview. Mind maps were constructed to appreciate the inter-relatedness of themes and evaluated using the SCCT framework. Methodology was anchored to the Consolidated Criteria for Reporting Qualitative Research checklist.ResultsSeven mentees were recruited. All were Chinese except for two Indians. All had less than six months experience with educational activities. None had formal training in medical education. Median duration postgraduate was six years. One was from a surgical discipline, others were from a range of medical disciplines. Themes identified included background influences, learning experiences and outcome expectations which affected self-efficacy, leading to mentees attaining goals and performing actions which effected their professional identity development, which was in-turn affected by contextual influences. Most perceived themselves as clinicians rather than medical educators. Concepts underpinning PIF included socialisation (role modelling and mentorship, communities of practice, sense of belonging), experiential learning, the hidden curriculum and reflective practice.ConclusionsNovice clinician educators mostly have a hierarchical identity. Role modelling and mentorship, active participation in communities of practice, promotion of a sense-of-belonging, experiential learning combined with reflective practice are important components for socialisation, synergistically facilitating PIF in novice clinician educators. Overcoming contextual barriers, being cognisant of cultural practices and addressing concerns in the hidden curriculum can assist educators in development of their professional identity.

The influence of social cognitive factors on physical activity of Chinese university students: The moderating role of gender

This study constructed a prediction model of physical activity among Chinese college students based on the social cognitive theory to investigate the factors and mechanisms influencing physical activity among Chinese college students. Questionnaires were dispensed to a cohort of 2000 university students hailing from 10 academic institutions located in Guangzhou, Guangdong Province, China resulting in the retrieval of 1897 questionnaires deemed valid. The conceptual framework was subsequently modeled using the PLS-SEM methodology based on the sample data collected. Sports social support (β = 0.191***), outcome expectation (β = 0.306***) and self-efficacy (β = 0.459***) positively impact college students' physical activity through self-regulation (β = 0.346***). Male self-efficacy has a weaker influence on self-regulation. Male college students' self-regulation also has a weaker effect on physical activity. External disturbance (β = -0.192***) negatively affects physical activity while internal disturbance has a minor impact (β = -0.135***, f2=0.010) almost negligible. The research validated the impact of various social cognitive elements on the exercise habits of university students. It offers a solid empirical foundation for advancing physical activity engagement among college students in China. Furthermore, the findings can serve as a fundamental reference point for Chinese educational institutions to develop comprehensive sports policies tailored specifically for college students.

Influenza and COVID-19 vaccines in pregnancy: investigation on associated factors and HAPA theory

Abstract Background Infections caused by influenza and COVID-19 during pregnancy represent a current public health problem as there are multiple populations at risk of complications: pregnant women, fetus, and future unborn children. The anatomical and physiological remodulation characteristic of pregnancy is responsible for the high pathological burden related to respiratory infections. Co-administration of influenza and COVID-19 vaccines may be beneficial because these two respiratory viruses cocirculate during cold weather. The need to explore pregnant women’s attitudes toward co-administration of influenza and COVID-19 vaccines and to evaluate factors associated with vaccine decision-making led to the conduct of this study. Methods In Palermo, Italy, during the 2021-2022 influenza season, a cross-sectional study was conducted to evaluate pregnant women’s intention to adhere to co-administration of influenza and COVID-19 vaccines. The determinants of vaccination attitudes were investigated through the administration of a questionnaire. The Health Action Process Approach theory (HAPA) was adopted to explore the cognitive behavioral aspects. Results Overall, 120 pregnant women were enrolled; average age 32 years, 98.2% (n = 118) of Italian nationality and 25.2% (n = 30) with obstetric or pathological conditions of pregnancy at risk. Factors significantly associated with attitudes toward co-administration of influenza and COVID-19 vaccines among pregnant women were: high level of education (OR = 13.96; p < 0.001), expectations of a positive outcome (OR = 2.84; p < 0.001) and self-efficacy (OR = 3.1; p < 0.001). Conclusions Vaccines co-administration could represent an advantageous preventive practice to facilitate vaccination logistics and allow full adherence to vaccinations recommended to pregnant women. Effective strategies to promote co-administration of influenza and COVID-19 vaccines could be focused on counselling about the expectation of positive outcomes of vaccine co-administration. Key messages • The need to explore pregnant women’s attitudes toward co-administration of influenza and COVID-19 vaccines and to evaluate determinants of vaccine decision-making led to the conduct of this study. • Vaccines co-administration could represent an advantageous preventive practice to facilitate vaccination logistics and allow full adherence to vaccinations recommended to pregnant women.

Outcome and life expectancy associated with novel subgroups of atrial fibrillation: a data-driven cluster analysis

Abstract Background/Introduction Atrial fibrillation (AF) presents a significant global health burden, affecting millions and associated with elevated risks of mortality, heart failure, and stroke despite current treatment strategies. The current diagnosis of AF relies on episode characteristics, yet its heterogeneity calls for personalized assessment incorporating clinical features, biomarkers, and substrate determination for improved classification and management. Purpose This study aimed to develop a refined classification of AF according to comprehensive risk factors to identify patients at high-risk for poor prognosis and their life expectancy, aiming to facilitate personalized interventions. Methods A total of 7,391 participants aged 40-69 with AF at baseline, from UK Biobank, were recruited in the main analyses. Firstly, LASSO regression with Cox model and factor analysis were adopted for identification and integration of principal risk factors. Second, Consensus clustering analysis was employed to estimate the optimal cluster number and group all 7,391 participants. Difference in the risk of death and major complications, as well as reductions in life expectancy, among clusters were estimated. Replication was done in 2,399 participants with newly diagnosed AF within two years after baseline. Results Risk factors for AF were categorized into seven aspects (metabolic factors, respiratory factors, cardiovascular factors, renal and immunity diseases, mental health, acute illness, age), based on the correlation between them. Five distinct AF clusters were identified according to these seven characteristics: acute illness-related (Cluster 1), mental health-related (Cluster 2), cardiovascular disease-related (Cluster 3), immune-and-renal disease-related (Cluster 4), and respiratory-and-metabolism disease-related AF (Cluster 5). Patients with respiratory-and-metabolism disease-related AF had the highest risk of death, acute myocardial infarction, heart failure, and cerebral ischemic stroke, while those with acute illness-related AF had the lowest corresponding risk. In addition, compared with individuals with acute illness-related AF, those with respiratory-and-metabolism disease-related and mental health-related AF had the top 2 greatest loss of life expectancy. Furthermore, genetic variants for AF had different effect among the five clusters. Replication analysis confirmed the result stability. Conclusion A novel AF classification was developed, which provided insights into varying life expectancy and risks of death and complications among AF subgroups with distinct characteristics. It offers a practical approach for identifying high-risk patients, which may help to tailor precise interventions for AF management.Graphic abstractCluster features

Assessment of psychosocial parameters in adolescents seeking orthodontic treatment

AimThe aim of this study was to investigate the psychosocial impact of malocclusion and the motivation for seeking orthodontic treatment among adolescents.MethodsA cross-sectional study included 102 adolescents (ages 11–18) whose malocclusion was rated using 3 occlusal indices: IOTN, DAI, and PAR. The participants answered three structured questionnaires selected to measure Oral Health Related Quality of Life (OHRQoL) through the short form of the Child Oral Health Impact Profile (COHIP), the patient's perceived impact related to orthodontics through the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), and self-esteem through the Rosenberg Self-Esteem Scale (RSES). Independent two-tailed t-tests, one-way mixed analysis of variance (ANOVA), and Spearman's correlations were used to test various associations.ResultsPatients with higher malocclusion scores displayed increased psychosocial impact with weak to moderate correlations (0.2 < r < 0.3; p < 0.05), but 98% wished their teeth looked better, and 70% were unhappy about their smile esthetics. The IOTN esthetic component AC was better associated with psychosocial implications of malocclusion (p < 0.01). Self-motivated patients (over 80%) had higher impactful psychosocial scores than patients whose parents were motivated for treatment. Sex did not influence the findings. Older adolescents and bullied individuals were more affected by the psychological burden of malocclusion.ConclusionThe results indicate the prevalence of psychosocial and esthetic impacts of malocclusion over oral and functional problems. PIDAQ discriminated better than COHIP between varying degrees of dental aesthetics. The results suggest that the orthodontist should explore patients' expectations of treatment outcomes, not only the chief complaint.

Prediction of physical activity and nutritional behaviors based on social cognitive theory in middle-aged population at risk of coronary artery disease in Bandar Abbas

AbstractCoronary artery disease (CAD) is the most common cardiovascular disease and the main cause of mortality in developing countries. Since physical activity and nutritional behaviors are modifiable risk factors in people at risk of CAD, the present study aims to explore the effect of an intervention based on the social cognitive theory (SCT) on physical activity and nutritional behaviors in middle-aged population at risk of CAD in the city of Bandar Abbas. The present cross-sectional study was conducted on 519 middle-aged subjects who visited the healthcare centers in Bandar Abbas, southern Iran, in 2023. The sampling was simple randomization. The data were collected using the general physical activity questionnaire, nutritional behavior questionnaire and a questionnaire based on the social cognitive theory (SCT). Descriptive statistics were used to describe the demographic features of the sample. Pearson correlation coefficient was used to test the relationship between the variables of study. Multiple linear regression was used to test the effect of the SCT constructs on physical activity and nutrition behaviors. All statistical analyses and hypothesis testing were done in SPSS 21, at a significance level of 0.05. A total number of 519 subjects participated in this study, whose average age was 44.23 ± 7.14 years. The results of Pearson correlation test showed a statistically significant positive correlation between nutritional behaviors and the constructs of self-efficacy, collective efficacy, outcome expectations, observational learning, normative beliefs, barriers and opportunities, reinforcement and punishment, and behavioral intention. There was also a significant positive correlation between physical activity and self-efficacy, normative beliefs, social support and behavioral intention. Social support, self-efficacy, normative beliefs, observational learning, behavioral skills and knowledge were found to be the predictors of physical activity. Reinforcement and punishment, normative beliefs, collective efficacy, social support and barriers and opportunities were the predictors of nutritional behaviors in the middle-aged population. As the results of the study showed, it is suggested to increase physical activity in the middle-aged population at risk of CAD using appropriate strategies to strengthen social support through family and friends, improve self-efficacy, identify positive and negative normative beliefs. Plans should be made to improve observational learning, increase behavioral skills, and increase knowledge to improve nutritional behaviors, use appropriate strategies to provide timely and appropriate rewards and punishments, identify and strengthen positive normative beliefs, improve collective efficacy, and increase social support. To this aim, families and other individuals around the middle-aged population can help remove barriers and create opportunities.

Validating measurement of social norms for entertainment-education: a five-factor model.

Though the measurement of social norms is important for evaluating entertainment-education interventions, there is a dearth of validity evidence for measuring tools to assess different social norm constructs. Identical survey items were used to assess family planning norms among married Zambian women in 2019 and 2022 following an entertainment-education radio program intervention. Confirmatory Factor Analysis was used for confirmation of the internal structure of several subscales used to measure social norms found in a previous study. There were no statistically significant demographic differences between participant groups at T1 and T2. CFA supported a five-factor model at T2 comprising descriptive norms (4 items), outcome expectations (3 items), and 3 different constructs capturing injunctive norms (3 items each). Results indicate good structural validity evidence for measuring social norms in entertainment-education using existing tools.

The association between perceived sensitivity to medicines, reported side effects and personal characteristics: A secondary analysis of an RCT.

A patient's perceived sensitivity to medicines (PSM) might influence the reported side effects of a treatment. The experience of side effects can result in personal and structural costs (such as nonadherence). Research on nocebo mechanisms and the workings of side effect reporting has been disproportionally smaller compared to the emerging evidence of the individual and clinical impact of the matter. In this study, we explored and re-examined the association between PSM and reported side effects within a specific population (chronic low back pain patients receiving acupuncture treatment), including possible mediating variables (i.e., gender, medical and nonmedical care utilization, optimism, pessimism, anxiety, depression and treatment expectation). We conducted a secondary analysis of a randomized controlled trial that examined the influence of treatment outcome expectations in chronic low back pain (CLBP) patients. All measures in the analysis were self-assessments. We explored the association between PSM, reported side effects and personal characteristics using correlational and regression analyses. Our sample consisted of 152 CLBP patients (65.8% female), the mean age was 39.5 years (SD = 12.5). We found positive correlations between PSM and reported side effects (r = 0.24; p < 0.01) and between PSM and anxiety (r = 0.21; p < 0.05). However, the subsequent regression analyses did not confirm a mediating or moderating effect of anxiety between PSM and reported side effects. We confirmed and extended earlier research on PSM. Our study involved a specific pain population receiving a nonpharmacological intervention. Our results highlight the importance of targeting PSM and anxiety within a treatment to take measures to mitigate the prevalence of side effects.

Introducing Resilience Outcome Expectations Scale: Development and Initial Validation

Introducing Resilience Outcome Expectations Scale: Development and Initial Validation

Psychological Determinants of Health Behavior.

This review provides a critical overview of current evidence on psychological health behavior determinants and its value in informing intervention and future determinants research. The review begins with work labeling and classifying the myriads of determinants available in the extant research to arrive at core groups of determinants. Next, the conceptual bases of these determinant groups are identified, and the weight of the evidence for their purported effects on health behavior, including belief-based determinants (e.g., outcome expectancies, capacity beliefs), determinants representing self-regulatory capacity (e.g., planning, action control) and nonconscious processes (e.g., habit, implicit cognition), and dispositional determinants (e.g., personality, regulatory control), is critically evaluated. The review also focuses on the theory-based mechanisms underpinning determinant effects and moderating conditions that magnify or diminish them. Finally, the review recommends a shift away from research on determinants as correlates, outlines how determinants can inform intervention development and mechanisms of action tests, suggests alternatives to predominant individualist approaches, and proposes future research directions.

Development and Validation of the TSTSIS Instrument to Measure Teachers’ Self-Efficacy to Teach Science Through Integrated STEM Approach

This study aimed to develop an instrument with acceptable validity and reliability for assessing two key aspects among science teachers: their self-efficacy in teaching science through an integrated STEM approach (STSIS) and their outcome expectancy when employing this approach (OETSIS), which we refer to as TSTSIS. We administered this tool to 109 science teachers in Phnom Penh city and various provinces in Cambodia. The results revealed that STSIS can be broken down into six essential latent factors. Among these factors, five are grouped under the theme of “Integrated STEM Instructional Self-Efficacy,” covering problem-based, robots-based, inquiry-based, engineering-based, and technology-based instructional self-efficacy. The sixth factor relates to teachers’ self-efficacy in terms of accessing materials. Author formulated the subscale “Expectations of High Students’ Achievement in Science” as the factor representing the OETSIS. Scores on the TSTSIS subscales offered evidence of its criterion validity, with significant differences observed across various teacher-related variables. These variables include teachers’ teaching qualifications, school types, teachers from schools where STEM education and an integrated STEM approach are part of the school’s objectives, and correlation with instructors’ teaching experience. The TSTSIS subscale lays the groundwork for designing STEM training programs tailored to the needs of science instructors.

Restaurants as Environments for Healthy Eating: Factors That Contribute to Restaurant-Based Healthy Eating Program Adoption.

Purpose. This study identified restaurant manager/owner factors that may contribute to adoption of a restaurant-based healthy eating program, Eat Fit. Findings may be used to engage restaurants in efforts to increase access to and availability of healthy foods, promote healthy food choices, and work toward improving diet and lowering obesity and chronic disease risk in the community. Methods. Cross-sectional survey data were collected from restaurant managers/owners interested in partnering with Eat Fit. Variables included restaurant manager/owner beliefs, perceived staff knowledge/skills, support, self-efficacy, outcome expectancies, and barriers and facilitators to implementation. Results. Forty-nine managers/owners participated. Most managers/owners held positive beliefs about offering healthy food items in restaurants (83.7%). Most agreed that restaurants could influence eating behaviors (83.7%) and that restaurants have a responsibility to offer healthy options (77.6%). Most managers/owners perceived high levels of support (83.7%) and were confident in their ability (95.9%) to implement the Eat Fit program. The most cited barriers were customer preference, ingredient availability, staff knowledge, and operational challenges. The most common reasons for involvement in the program were a desire to increase access to healthy food, to entice customers looking for healthier food, a belief that restaurants should offer healthy food, and opportunities to market through Eat Fit. Conclusions. This research contributes to knowledge about beliefs and perceptions of restaurant manager/owners. Efforts to engage restaurants should focus on benefits of offering healthy food and the role restaurants can play in promoting health. Furthermore, programs may benefit from enhanced restaurant staff training, customer-targeted marketing, and educational efforts.

Predicting Futile Recanalization After Endovascular Thrombectomy for Patients With Stroke With Large Cores: The SNAP Score.

We aimed to develop and validate a prediction score for futile recanalization (FR) for large vessel occlusion (LVO) presenting low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) for patients who underwent endovascular thrombectomy (EVT). Patients with anterior circulation LVO with low ASPECTS (<6) who underwent successful EVT (modified treatment in cerebral ischemia score ≥2b) from Stroke Thrombectomy and Aneurysm Registry were retrospectively analyzed. FR was defined as 90-day modified Rankin Scale (mRS) scores ≥4 despite successful EVT. Multivariable logistic regression was used to identify independent predictors of FR, and they were used to create a clinical score. The performance of the score was assessed by receiver operating characteristic curve analyses. Of 219 patients, 170 and 49 patients were randomly assigned to the training and validation cohort, respectively. Independent predictors of FR identified in the training cohort were used to construct the SNAP score: site of occlusion (middle cerebral artery = 0, internal carotid artery = 1), National Institutes of Health Stroke Scale score at admission (≤10 = 0, 10 to 19 = 1, ≥20 = 2), age (<75 = 0, ≥75 = 2), and prestroke mRS score (0-3). Receiver operating characteristic curve analyses of the SNAP score in the training and validation cohorts showed areas under the curve of 0.79 (95% CI 0.72-0.86) and 0.79 (95% CI 0.65-0.92) for predicting FR, respectively. A SNAP score ≥5 had a positive predictive value of 92.1% [95% CI 78.8%-97.3%] for FR. The SNAP score may be useful in predicting FR after EVT in low-ASPECTS patients with LVO. It can provide patients, family members, and physicians with reliable outcome expectations among patients with acute ischemic stroke with large infarcts.

Environmental Responsibility in Urban Forests: A Cognitive Analysis of Visitors’ Behavior

The environmentally responsible behavior of urban forest visitors is a key determinant for the conservation of urban forests. Identifying the determinants of individuals’ behavioral intentions and actual behavior in engaging in environmentally responsible actions is a crucial step in promoting such behavior. This research investigates the determinants of environmentally responsible behavior of urban forest visitors in Tehran using Social Cognitive Theory. Data for the study were collected using 456 questionnaires distributed to visitors of urban forests. The data were analyzed using structural equation modelling, which described a 62.9% variance in behavioral intention and 56.6% in environmental behavior of visitors. The socio-structural factors and the observation of others’ behaviors were the most significant predictors of behavioral intentions. Outcome expectations and self-efficacy significantly influence both behavioral intentions and actual behavior. This study demonstrates that while behavioral intention is a key factor, other determinants such as outcome expectations and self-efficacy play a crucial role in shaping actual environmentally responsible actions. These results underscore the importance of increasing awareness and enhancing the skills of urban forest visitors regarding environmental behaviors. Furthermore, this study highlights the need to remove barriers and provide the necessary facilities to promote sustained environmentally responsible behavior among visitors.

Influence of career awareness on STEM career interests among foundation-year students in Mogadishu, Somalia

This study investigates the influence of career awareness on STEM career interests among Foundation-year students in Mogadishu, Somalia. By examining self-efficacy, outcome expectations, and academic performance as mediating factors, the research provides new insights into the complex relationships that shape students’ aspirations in STEM fields. Data were collected through a survey of 321 students across four private and public universities and analyzed using Structural Equation Modeling in R-Programming to ensure rigorous evaluation of validity and reliability. The findings reveal that self-efficacy plays a pivotal role in motivating students to pursue STEM careers. At the same time, positive outcome expectations and academic achievements further reinforce their interest in STEM pathways. Although the direct relationship between STEM career awareness and career interests was not statistically significant, the results emphasize the importance of fostering self-belief among students. This study contributes to the understanding of the multifaceted factors influencing STEM career interests and offers practical strategies to enhance self-efficacy, positive outcome expectations, and academic excellence. These findings can inform the development of interventions aimed at inspiring and empowering students in their pursuit of STEM careers.