Adverse events to patients continue to be a significant global concern. Although some of these events are preventable through improved safety behaviours among nurses, research has primarily focused on safety culture, safety systems, and policy, often overlooking individual factors such as nurses' safety behaviours. A deeper understanding of the factors influencing nurses' compliance with patient safety protocols and their active participation in safety initiatives is essential for promoting safer patient care. In this review, we aim to identify factors that determine nurses' patient safety behaviours-both patient safety compliance and participation-and highlight existing research gaps. A scoping review was conducted in November 2023 utilizing the databases PubMed, CINAHL, PsycINFO, Web of Science, and Ichushi-Web. Two researchers independently screened articles for inclusion. The factors influencing patient safety behaviours were extracted from the selected studies and categorized based on their characteristics and relevance. Of the 286 articles screened, 5 were included. Factors influencing nurses' patient safety behaviours were categorized into the following groups: contextual (patient safety climate, hospital characteristics, and job demands); individual (motivation, perception of patient safety behaviours, experience with patient safety, knowledge of patient safety, and demographic characteristics); and cross-level interaction (contextual × individual factors). Our findings underscore the importance of addressing both contextual and individual factors in promoting nurses' patient safety behaviours. Nurse managers should develop patient safety systems while also understanding the individual factors influencing patient safety behaviours and their interaction with the broader organizational context.

Perception and safety behaviors in pesticide usage among farmers in Brebes regency: Efforts to enhance pesticide safety

This study aimed to investigate the impact of 'who' delivers a health message (general practitioner or community representative), and the 'visual stimulus' (animation or talking head) used on influencing attitudes toward safe behaviours in the context of the COVID-19 pandemic, across six vulnerable population subgroups STUDY DESIGN: A 'helix' randomised controlled trial with 2x2 factorial design. Participants (40 per subgroup) were randomly allocated within their subgroup to an intervention sequence. They completed a factorial, counter-balanced allocation of four intervention combinations across four safe behaviour contexts. Exposure to each intervention was followed by online survey questions investigating intention to undertake, and encourage family and friends to undertake, the context-specific behaviour using a 5-point Likert-style scale RESULTS: A total of 358 participants responded to requests to participate in the study, of whom 298 (83%) fully completed and 58 (16%) partially completed surveys. Participants were more likely to report higher intention to perform COVID-safe behaviours when exposed to animation compared to talking head visual stimuli (Coef=-0·12, 95% CI=-0·22 to -0·01, p=0·03; β=-0.12, 95% CI -0.22 to -0.01, p=.03, animation>talking head) There was no main effect of 'who' provided the message; however, several interaction effects were noted across population subgroups for each intervention. The approach best suited for different vulnerable subgroups varies across each, indicating a one-size-fits-all approach should not be used and is inequitable. However, the additional costs and time-delays that would be encountered in preparing subgroup-specific materials also warrant consideration.

Children in urban areas face elevated risk for bicycle-related injuries, yet few evidence-based curricula address bicycle safety for elementary school physical education (P.E.) settings. The BikeSafe Elementary School Curriculum (BESC) is an off-bicycle, standards-aligned program for grades 2-5. From August 2024 to May 2025, P.E. teachers at nine Miami-Dade County public elementary schools implemented the BESC with grades 2-3 (ages 7-8) and 4-5 (ages 9-11). Students completed pre-post assessments. McNemar's test evaluated pre-post changes for each question; the Wilcoxon signed-rank test assessed total score changes. Data from 159 younger and 85 older students showed significant gains: grades 2-3 improved their knowledge assessment scores from 14.99 (SD = 2.18) to 16.70 (SD = 1.76, p < 0.001), and grades 4-5 from 21.80 (SD = 2.21) to 23.32 (SD = 2.01, p < 0.001). Both younger and older students improved on the concepts of visibility, hand signals, and built environment awareness. BESC's minimal equipment needs support integration into P.E. programs, particularly in underserved or high-risk schools. Broader adoption may enhance youth injury prevention and safe cycling behaviors. BESC improved safety knowledge and is a scalable and alternative to on-bike instruction in elementary school settings.

Public sunscreen dispensers and sun-protective behaviours: an observational study in Toronto, Canada.

Road safety remains a major public health concern, especially in low and middle-income countries, such as Indonesia; it is closely linked to unsafe driving behavior, along with poor awareness of safety and erroneous perception of risk. Although various training programs are already established, there is limited empirical evidence to identify which configuration produces the greatest safety improvement. This study explicitly aims at analyzing the effects of training characteristics, including the number of sessions, total duration, and training delivery format, on transportation safety outcomes of university students. The research had an experimental pre-post design, with 32 participants. Safety was measured along different dimensions, namely safety attitude, positive safety behaviour, negative safety behaviour, safety violations, and safety knowledge. Safety improvement was defined as the difference in total safety scores post-training and pre-training. Multiple linear regression revealed that total duration, the number of sessions, and training delivery significantly affect the improvement in safety at the 0.05 level. To find a suitable solution, a Genetic Algorithm was used to optimize the solution. The results show that 8 sessions of 1 hour are better than 1 session lasting 8 hours. This is in line with more traditional learning theory that repeated presentations over a given period are more effective for learning and behavioral response. Also, the gap between the 8x1 sessions offered a period over which adjustments could be made. Overall, the results highlight the value of training delivery formats on transportation safety improvements.

ABSTRACT Lowering speed limits to 30 km/h (20 mph) is an increasingly adopted policy with anticipated public health benefits, yet evidence on these impacts is limited. This natural experimental study evaluated the impacts of a city-wide 30 km/h speed limit policy in Amsterdam, The Netherlands, on physical activity, child safety, and social interactions. Four intervention streets (reduced from 50 km/h to 30 km/h) were compared with two matched control streets (remained 50 km/h) at baseline (October–November 2023) and one-year follow-up (October–November 2024). Systematic street observations assessed physical activity behaviours (walking, cycling, cargo bike, child seat use), child safety indicators (helmet use, children under adult supervision), and social interactions (alone/in group, conversing). Multilevel regression models estimated intervention effects by age group (children, teenagers, adults), adjusting for day, time, and precipitation. Compared to controls, intervention streets showed significant increases in children cycling, children in child seats, adults in groups, and adults conversing. Teenagers observed alone decreased, while children alone increased. No significant changes were found for walking, cargo bike use, helmet use, or supervision. This is one of the first natural experimental studies suggesting that 30 km/h speed limits may produce benefits beyond road safety, supporting children’s independent travel and promoting social interactions.

A substantial proportion of construction accidents is associated with unsafe worker behavior. Identifying their underlying mechanism is vital for designing effective interventions. As prior studies could not capture complex nonlinear interactions among organizational and individual factors, this study leverages machine learning (ML) techniques, which can capture complex relationships by handling large datasets, and can identify patterns in worker behavior. The study proposes an explainable ML model to interpret key determinants of safe behavior. The data were collected from 425 construction workers in Saudi Arabia. Multiple ensemble and benchmark ML algorithms—including random forest (RF), categorical boosting, decision jungle, light gradient boosting machine, support vector machine, and adaptive boosting—were implemented and compared. The results indicate that the RF model achieved the best predictive performance, outperforming several competing models. To enhance the model’s interpretability, explainable artificial intelligence (XAI) techniques were applied to reveal the interaction of key predictors influencing workers’ behaviors. The results demonstrate that safety communication, risk perception, and supportive work environment are the most influential determinants shaping safety behavior. As a key novelty, this study introduces an ML-based approach for predicting construction workers’ safety behavior and applies XAI techniques to systematically interpret the key determinants of safety behavior. The results also provide valuable insights for safety managers and offer data-driven guidance to enhance the effectiveness of safety interventions.

Simulation-based training (SBT) has emerged as a structured educational strategy to support safe transition into clinical imaging practice. In nuclear medicine technology (NMT), where high-risk procedures require precision and adherence to radiation protection standards, variability in clinical-based training (CBT) exposure may affect skill acquisition. Evidence evaluating structured simulation integration within undergraduate nuclear medicine education remains limited. This study aimed to evaluate performance outcomes associated with SBT and CBT using a structured OSCE framework to assess competency acquisition, procedural performance, and radiation safety preparedness among undergraduate nuclear medicine students. A comparative educational evaluation was conducted involving two undergraduate NMT cohorts from separate institutions in Riyadh, Saudi Arabia (SBT, n = 30; CBT, n = 30). Students underwent a structured four-station objective structured clinical examination (OSCE) in a controlled hot laboratory environment assessing theoretical knowledge, radiopharmaceutical dose preparation, dose calibrator operation, and radiation safety management. Normality of the data was assessed using the Shapiro-Wilk test, and homogeneity of variances was evaluated using Levene's test. Independent-samples t-tests with Welch's correction were used to compare group means between SBT and CBT groups. For variables where assumptions were violated, the non-parametric Mann-Whitney U test was applied. Bonferroni correction was applied to account for multiple comparisons (p < 0.0125). Students trained using simulation demonstrated higher mean scores across all OSCE stations compared with clinically trained peers. Statistically significant differences were observed in stations 2, 3, and 4 (all p < 0.001), favoring the SBT group and remaining significant after Bonferroni correction. Higher mean performance was also observed in theoretical knowledge; however, this difference was not statistically significant. Simulation-based training was associated with higher mean performance across assessed competencies, with statistically significant differences observed in practical and safety-related OSCE stations (stations 2-4). While no significant difference was observed in theoretical knowledge, these findings suggest that structured simulation may enhance procedural readiness and reinforce radiation safety behaviors in undergraduate nuclear medicine education when integrated alongside clinical training.

Psychological safety and teacher voice behavior: Power distance orientation in Chinese schools.

Assessing Food Safety Knowledge, Skills, and Practices Among Handlers and Consumers in the Dominican Republic.

This study evaluated the impact of an elementary school-based intervention that aimed to improve sun safety knowledge and behaviors among third- and fourth-grade students in Pennsylvania through an educational video, t-shirt design contest, and interactive assembly. From pre-survey (n = 88) to post-survey (n = 86), students showed significant improvements in awareness of the link between sun exposure and skin cancer (p < 0.001). Between pre-survey and 6-month follow-up (n = 67), no significant changes were found in reported sunscreen use and reapplication, hat-wearing, or sunburn incidence, but knowledge of skin cancer risk from the sun remained high (p < 0.001). In summary, the intervention significantly increased awareness of the link between sun exposure and skin cancer, with knowledge remaining high at 6-month follow-up, but sustained behavioral change was not observed, suggesting a need for continued reinforcement or different intervention.

High-quality radiotherapy requires accurate dose delivery to target volumes while protecting organs-at-risk (OARs). However, current clinical workflows remain constrained by labor-intensive multidisciplinary collaboration, prolonged planning cycles, and limited scalability. Intelligent automation capable of integrating clinical knowledge and real-world decision patterns is needed to enhance precision and efficiency in radiotherapy planning. This study proposes MARTP, a \textbf{M}ulti-\textbf{A}gent \textbf{R}adiation \textbf{T}herapy \textbf{P}lanning framework driven by large language models (LLMs), to emulate multidisciplinary clinical workflows and enable end-to-end intelligent radiotherapy planning and evaluation.&#xD; Approach: MARTP coordinates five specialized agents to integrate data analysis, weight adjustment, plan optimization, plan evaluation, and report generation into a unified radiotherapy planning workflow. The framework leverages supervised fine-tuning (SFT) on expert weight adjustment demonstrations to improve adaptation to complex clinical cases, incorporates retrieval-augmented generation (RAG) to ground planning decisions in case-specific knowledge, and employs a predefined model-context protocol (MCP) to enable high-precision treatment plan generation. In addition, reinforcement learning (RL) with expert preference data is used to develop an intelligent plan evaluation mechanism.&#xD;Results: Statistical analysis reveals that the dosimetric metrics of plans generated by MARTP exhibit no statistically significant differences compared with expert-crafted clinical plans, while the planning efficiency is substantially improved. In addition, the framework demonstrates robust and safe behavior under abnormal input scenarios, maintaining clinically acceptable outputs. The SFT and RL components further enhance the consistency, semantic accuracy, and reliability of model-generated weight adjustments and plan evaluations.&#xD;Significance: MARTP demonstrates that LLMs-driven multi-agent systems can effectively replicate multidisciplinary radiotherapy workflows, generating clinically comparable plans with substantially improved efficiency. The framework provides a promising pathway for integrating intelligent automation into radiotherapy practice, supporting more consistent decision-making and scalable treatment planning.

Introduction: Workplace safety is a critical factor for organizational success and the protection of humancapital. Safe behavior among employees is influenced by various psychological and organizationalfactors, including safety climate and safety motivation. Considering the importance of enhancing safetymotivation and the lack of standardized indigenous tools in Iran, this study aimed to culturally adapt theSelf-Determination Safety Motivation Scale (SDSM) and examine its mediating role in the relationshipbetween safety climate and employees’ safe behavior at Kavir Steel Complex in Aran and Bidgol County. Material and Methods: This analytical cross-sectional study was conducted in 2024 among 256production line employees. Data were collected using the Safety Climate Questionnaire, the Safe BehaviorQuestionnaire, and the Persian-adapted SDSM. The adaptation process included forward–backwardtranslation, content validity evaluation by experts, and confirmatory factor analysis. Data were analyzedusing SPSS version 26 and structural equation modeling with SmartPLS version 4. Results: The findings indicated that safety climate had a positive and significant effect on safe behavior (β= 0.608, p &lt; 0.001), and safety motivation significantly mediated this relationship (β = 0.388, p &lt; 0.001). Itis noteworthy that the direct relationship between safety climate and safety motivation was significantlynegative. The structural model explained approximately 42% of the variance in safety behavior (R² =0.419), indicating satisfactory predictive power. Model fit indices (NFI = 0.91, SRMR = 0.06) demonstrateda satisfactory model fit. Convergent validity, discriminant validity, and construct reliability were allconfirmed at acceptable levels. Conclusion: The results highlight the importance of fostering a positive safety climate and strengtheningemployees’ intrinsic motivation in high-risk environments to reduce workplace accidents and promoteorganizational health. These findings can serve as a foundation for policy-making and training programsin the field of HSE

This study examines the pre-program knowledge levels, needs and expectations of preschool teachers and parents regarding disasters, first aid and psychological resilience, with a view to informing the development of an early childhood disaster resilience education program. The study was conducted using a qualitative case study design, with data being collected through semi-structured interviews with 17 preschool teachers and 48 parents. The collected data were analysed using both descriptive and content analysis methods, with the MAXQDA software. Both teachers and parents emphasised the importance of educating children about natural disasters in an age-appropriate and psychologically safe manner. While teachers focused on drills, safety behaviours and emotional regulation, parents highlighted disaster kit preparation and communication strategies. The use of art was seen as a critical tool for emotional expression and psychological recovery by both groups. The results indicate that preschool teachers and parents perceive a strong need and express support for the development of a developmentally appropriate and holistic disaster resilience education program for early childhood.

Abstract Background Autism spectrum disorder (ASD) without intellectual disability may be identified late in adolescence when the presenting complaint is dominated by internalizing distress and functional decline rather than explicit neurodevelopmental concerns. Social anxiety is among the most frequently reported comorbidities in adolescents with ASD. We report the case of an adolescent with late identified ASD and prominent social anxiety who received an autism adapted cognitive behavioral therapy (CBT) program. Case presentation Maxence is a 13-year-old boy referred for progressive social withdrawal, severe freezing in evaluative school situations, and escalating screen-related behaviours with family conflict. A multi-informant multidisciplinary assessment supported autism spectrum disorder level 1 without intellectual disability, with prominent social anxiety and clinically significant alexithymic features. Treatment was complicated by low initial motivation, over-analysis, poor emotional differentiation, avoidance of homework tasks, and screen use as a rapid tension regulator. Treatment followed a phase-based autism-adapted cognitive behavioral programme combining a highly predictable therapeutic frame, early somatic cue detection, minimal emotional labeling, brief protective scripts, planned graded exposures with reduction of safety behaviors, structured family guidance, and school coordination. The intervention was adapted by lowering performance demands, using body-first emotional work, replacing silence with brief rescue sentences, making exposure predictable and repeatable, and modifying the tension-to-screen-for-relief contingency rather than focusing on screen time alone. Symptoms and functioning improved from baseline to post-treatment and at 3-month follow-up, with reduced anxiety and freezing, better engagement in school and daily activities, and improved regulation of screen use. Conclusions This case study supports an integrated mechanistic formulation and a structured autism adapted CBT approach to reduce the cost of exposure and restore functional engagement in late-identified autistic adolescents with prominent social anxiety.

ABSTRACT Despite smoking at lower rates, Black adults who smoke face disproportionate tobacco-related health disparities, including higher nicotine dependence, exposure, and lower cessation rates compared to other racial groups. Smoking motives play a critical role in smoking maintenance and relapse. Anxiety sensitivity (AS), a transdiagnostic cognitive-affective construct, has emerged as a strong predictor of smoking motives (habit, affect reduction, sensorimotor, and stimulant motives) among Black adults who smoke. However, mechanisms underlying this relationship remain unclear. False safety behaviors (FSB), or behaviors used to alleviate symptoms of anxiety and stress in response to phobic stimuli (i.e. false threats), may serve as a mechanism between AS and smoking motives. The current study examined the indirect effects of FSB in the relationship between AS and smoking motives (habitual, addictive, negative affect reduction, pleasure, stimulation, and sensorimotor) among Black adults who smoke. Participants included 78 (28.2% female; M age = 43.5 years, SD = 11.7 years) Black adults who reported current daily smoking. Results showed that AS was indirectly associated with all smoking motives through FSB (all p’s < .001-.02). The current results highlight the importance of FSB utilization as a targetable mechanism for smoking cessation treatments for Black adults who smoke and who experience elevated AS.

Severing the health-impairment chain: Psychological distress and cross-level safety climate associations with safety behavior.

This study examines concussion knowledge, attitudes, and behaviors among European American football athletes using an online survey. Data from 256 players (mean age 26.8 years (SD 4.9); 7.4 (SD 4.5) years of experience) across some of the highest leagues (Austrian Football League, German Football League, European League of Football) revealed an average concussion knowledge index of 17.9 (SD 2.3) of 25 and an attitude index of 63 (SD 6.3) of 75. Notably, 43.1 % of athletes reported they would continue to play despite experiencing concussion symptoms indicating a gap between knowledge, attitudes, and safe behavior. These findings underscore the need for targeted educational measures to improve the transfer of knowledge toward safer decision-making processes and to strengthen the prevention and management of concussions.

How does caring affect the safety behavior of construction site workers?