Moderating Effect of Perceived Threat of Breast Cancer on Relation between Knowledge and Breast Self Examination

Estimated at more than 2.2 million cases worldwide,most breast cancer cases and deaths from breast cancer occur in low and middle-income countries.In Cameroon,many studies have underlined the effect of knowledge of breast cancer on screening measures such as self-examination and,to a lesser extent,the perception of the threat of this disease.This research aims to assess according to the Health Belief Model(HBM),the moderating effect of perceived threat of breast cancer on the relation between knowledge and breast self-examination.A questionnaire survey was conducted among 517 Cameroonian women to assess their general knowledge about breast cancer(risk factors and screening measures),their level of the perceived threat of breast cancer through Perceived susceptibility and severity,and the prevalence of breast self-examination amongst them.A regression analysis using the Macro Process for moderation indicates the main effect of Perceived threat(b=0,29;t(517)=2,36;p=0,02)of breast cancer and knowledge(b=0,02;t(517)=4,29;p<0,001)on breast self-examination.Results also confirm that the perceived threat of breast cancer moderates the effect of knowledge on breast self-examination.While the low level of perceived threat highlights the effect of knowledge on breast self-examination(b=0,02;t(517)=3,49;p<0,001),the high level of perceived threat cancels that effect(b=0,01;t(517)=1,97;p=0,01).A woman who perceives severity and susceptibility to breast cancer is more inclined to perform breast self-examination.This result suggests the importance of taking into account,in a context where knowledge of breast cancer is limited,relevant factors of the health belief model in preventive measures against breast cancer in general and the practice of breast self-examination in particular.

Perceived stress among staff in Saudi Arabian dental colleges before and after an accreditation process: A cross-sectional study

BACKGROUND Accreditation processes are extensively employed to guarantee the quality of higher education institutions.However,this process can potentially generate a stressful atmosphere for staff,thus impacting their ability to perform optimally under pressure.AIM To examine the knowledge of the National Commission for Academic Assessment and Accreditation(NCAAA)and its effects on perceived stress among dental college staff before and after the program accreditation process.METHODS The present cross-sectional questionnaire-based study included 300 employees from three dental colleges.The same employees had to fill out the questionnaire 1 mo after the NCAAA process.RESULTS Approximately 51.33%of the included employees believed that NCAAA is essential to attract quality students to join the program before and after the program.A total of 44.67%felt that their stress was high before,and 31.33%had low stress levels before and after NCAAA.These findings were statistically significant(P≤0.05).CONCLUSION NCAAA raised the prestige of the institution and specific programmes and increased prospects to attract better students,staff,and money,according to the employees.In addition to their needed teaching,research,and other service responsibilities,this work requires a tremendous amount of faculty effort and may cause them stress.

Application of Perceived Teaching with Moderate Elimination of“Graphics”in Architectural Design Courses

Starting from the traditional form of“graphic”architectural education,this paper explores a teaching method of entity construction experience,instrument assistance,and digital virtual expression symbiosis symbiosis from three aspects:environmental perception,ontology perception,and extension perception.Using physical perception as a medium,and gradually rising from active perception to a comprehensive expression of visual audience perception through practical operation,it allows students to have a more comprehensive understanding of the meaning of architectural design on the basis of the“graphic”expression paradigm.

Linking Perceived Risk of Public Health Emergency to Psychological Distress among Chinese College Students: The Chain Mediation Role of Balanced Time Perspective and Negative Coping Styles

Background:With public health emergencies(PHE)worldwide increasing,the perceived risk of PHE has been one of the critical factors influencing college students’psychological distress.However,the mechanisms by which the perceived risk of PHE affects college students’psychological distress are not clear.The study’s purpose was to investigate the mediation roles of deviation from a balanced time perspective(DBTP)and negative coping styles between the perceived risk of PHE and psychological distress.Methods:A convenience sampling method was used to survey 1054 Chinese college students with self-reporting.Data was collected using the Public Risk Perception Scale(PRPS),the Zimbardo Time Perspective Inventory(ZTPI),the Simplified Coping Style Questionnaire(SCSQ),the PHE Anxiety Scale,and the Chinese version of the Patient Health Questionnaire(PHQ).The associations between the perceived risk of PHE,DBTP,negative coping styles,and psychological distress were clarified using the correlation analysis.Additionally,the mediating roles of DBTP and negative coping styles between the perceived risk of PHE and psychological distress were investigated using a structural equation model.Results:The findings revealed low to moderate correlations between the variables studied.Students’perceived risk of PHE was a positive predictor of their psychological distress(b=0.219,p<0.01).DBTP and negative coping styles played chain mediation roles between them with the effect being 0.009 and a 95%Boot CI of[0.003,0.023].This chain mediation model had an excellent fit index(χ^(2)/df=4.732,CFI=0.973,TLI=0.930,RMSEA=0.048,SRMR=0.047).Conclusion:These findings showed how the perceived risk of PHE affected college students’psychological distress.Specifically,these results suggested that improving students’mental ability to switch effectively among different time perspectives depending on task features and situational considerations and reducing their negative coping styles might be effective ways to promote their mental health.

The Association between Perceived Injustice Following Traumatic Injury and Its Impact on Pain-Related, Mental Health and Functional Health Outcomes: A Systematic Review

Background: There is growing evidence suggesting that those who suffer traumatic injury display high levels of perceived injustice which impedes their recovery, both physically and mentally. Aim: The aim of this systematic review was to examine the association between perceived injustice and pain-related, mental health and functional outcomes in patients who have suffered a traumatic injury. Methods: In May 2023, a systematic review of the literature was performed on the electronic databases of PubMed, Google Scholar, Embase, and the Cochrane Database of Systemic Reviews. Papers were collected and analysed as per PRISMA guidelines for systematic reviews. The outcomes of interest were pain intensity, pain interference, disability, depression, anxiety, and quality of life. The initial search identified 59 papers. Of these papers, five studies met the inclusion criteria and were subsequently analysed (N = 1172). Each of the papers was published in peer-reviewed journals in the English language. Individuals with pain or pathology prior to the trauma and those who were not hospitalised following the trauma were excluded from the study. Results: Of the papers reviewed, each study indicated significant associations between perceived injustice and pain, disability, depression, anxiety, post-traumatic stress disorder, as well as reduced return to work status. Conclusion: This systematic review investigated the relationship between perceived injustice and pain-related, mental health, and functional outcomes in trauma patients. The results highlight the negative role that perceived injustice has on recovery following traumatic injury. Further, it provokes the need for future research regarding the implementation of therapeutic interventions and the development of predictive models of injustice.

Latent profile analysis of perceived stress and influencing factors in colorectal cancer patients

Objective:To understand the latent categories of perceived stress in colorectal cancer patients and analyze the characteristics of different categories of patients.Methods:A total of 255 colorectal cancer patients receiving treatment in the gastrointestinal surgery and oncology depar tments of a ter tiary Grade A hospital in Sichuan Province,from January 2023 to June 2023,were selected as the study subjects.General information questionnaire,Chinese version of the Perceived Stress Scale(CPSS),and Comprehensive Score Table for Patient-Repor ted Outcome Measures of Economic Toxicity(COST-PROM)were used for data collection.Results:Perceived stress in colorectal cancer patients was classified into 3 latent categories:C1“Low stress-stable type”(19.2%),C2“Moderate stress-uncontrolled type”(23.9%),and C3“High stress-anxious type”(56.9%).The average score of perceived stress was(34.07±5.08).Compared with C1 type,patients with a monthly household income of≤3000 RMB were more likely to belong to the C2 and C3 types(P<0.05),and patients without a stoma were less likely to belong to C3 type(P<0.05).Compared with C2 type,male patients were more likely to belong to C3 type(P<0.05),and patients without a stoma were less likely to belong to C3 type(P<0.05).Compared with C3 type,patients with higher economic toxicity scores were more likely to be classified into C1 and C2 types(P<0.05).Conclusions:Perceived stress in colorectal cancer patients exhibits distinct categorical features.Male gender,lower income,presence of a stoma,and higher economic toxicity are associated with higher levels of perceived stress in colorectal cancer patients.

The Relationship between Mental Health Literacy and Subjective Well-Being of Young and Middle-Aged Residents: Perceived the Mediating Role of Social Support and Its Urban-Rural Differences

This study investigates mental health literacy among young and middle-aged urban and rural residents and the differences in mental health literacy,perceived social support and subjective well-being.From January to February 2022,620 participants(320 rural and 300 urban residents)from three provinces of China were selected by con-venience sampling.A general data questionnaire,mental health literacy scale,perceived social support scale and subjective well-being scale were administered.The mental health literacy scores of urban residents were 3.34±0.57 and those of rural residents were 2.73±0.79.The results of multiple regression analysis showed that the mental health literacy scores of rural residents were more significant than those of urban residents in terms of sex and age,while urban residents’mental health literacy scores were more significant than those of rural resi-dents in terms of monthly income.Mental health literacy,perceived social support and subjective well-being of young and middle-aged urban and rural residents were all positively correlated(P<0.01).While the level of mental health literacy is better among urban residents than rural residents,perceived social support plays a partial mediating role between mental health literacy and subjective well-being of both urban and rural residents,and should be the focus of researchers seeking to improve the level of well-being of residents.

Relationship between Moral Elevation and Prosocial Behavior among College Students: The Mediating Role of Perceived Social Support and Moderating Role of Moral Identity

Objectives:The present study examined the relationship between college students’moral elevation and prosocial behavior.As well as the mediating role of perceived social support and the moderating role of moral identity.Methods:A sample of 489 college students were recruited for the study.They were asked to complete a series of questionnaires,including Moral Elevation Scale(MES),Perceived Social Support Scale(PSSS),Moral Identity Scale(MIS)and Prosocial Tendency Measure(PTM).As part of the data analysis,we used correlation analysis and the method of constructing latent variable structural equation model to explore the mechanism of action among variables.Results:After controlling for gender,discipline,the research found that:(1)Moral elevation positively predicted the prosocial behavior among the college students;(2)Perceived social support mediated the relationship between moral elevation and prosocial behavior;(3)Moral identity moderated the second half of the model(i.e.,the link between perceived social support and prosocial behavior).Specifically,the mediating effect of perceived social support was stronger for college students with high-level moral identity compared to those with low-level moral identity.Conclusions:Moral identity significantly moderates the mediating effect of perceived social support,and the mediating model with moderated is established.

Maternal perceived self-efficacy, perceived vulnerability and child health outcome in Ibadan, South-West Nigeria

Objective:The problems associated with child health continue to constitute a global concern,and child morbidity and mortality remain problematic in Sub-Sahara Africa(SSA).Utilizing a community-based survey conducted in Ibadan North Local government,Southwest Nigeria the study examined the influences of maternal perceived self-efficacy(MPSE)and maternal perceived vulnerability(MPV)on child health outcomes(CHO).Methods:The study appraised data from 683 nursing mothers aged 15-45 obtained from 20 major primary healthcare centers in the region undergoing routine health checks for their children.Three regression models were fitted to examine the effects of MPV,MPSE,and confounding variables of maternal preventive actions such as insecticide-treated nets(ITN)usage and child immunization,among other maternal and child sociodemographic attributes on CHO.Results:The study finds that MPV has no correlation with CHO and MPSE but positively correlates with maternal age(r=0.123,P<0.05).However,CHO has a negative correlation with MPSE(r=-0.200,P<0.05)while positively correlated with child age(r=0.134,P<0.05).MPSE has a unique effect on CHO(β=-0.203,P<0.05),maternal preventive action of ITN usage show a positive association with CHO in the study Model 2(β=-0.163,P<0.05),while in Model 3,child's age has a positive association with CHO(β=0.180,P<0.05).The net effect of the study models accounted for approximately 10%of the variance in CHO reported among the children.Conclusion:Overall,MPSE and ITN usage are essential factors for understanding and reducing the potential adverse CHO.Global effort must continue to improve maternal education to support child health and preventive carepractices in SSA.

Perceived Barriers to Cervical Cancer Screening Using Pap Smear Test among Women Attending Saad Abu Al Ella Hospital in Khartoum State, 2022

Background: Cervical cancer is the second common cancer among women worldwide. It is a preventable cancer, and early detection of precancerous conditions through the Papanicolaou cytology screening (Pap smear) is a key aspect of prevention;it is accepted worldwide as an efficient tool for secondary prevention. While the PS test is simple, inexpensive, and relatively reliable as a method of diagnosing cervical cancer, most women do not take the test. Therefore, this study is sought to describe the barriers to pap smear uptake among Sudanese women. Materials and Method: This total coverage observational, analytical and cross sectional, hospital-based study was conducted in Saad Abu El Ella Hospital in April 2022. The study was conducted using an anonymous questionnaire to assess the perceived barriers of 93 participants. All data were computerized using Microsoft Excel’17 and the data were described and analyzed using statistical package for social science (SPSS23). Results: The findings revealed that the mean age of the participants was 39.5 years and only 3.2% had ever undergone a pap smear test. Identified barriers were lack of information, not knowing where to go, and fear of pain. The majority, 72% are willing to routinely perform a pap smear test if well informed about it. The study also demonstrates that there is a significant correlation between perceived barriers score and willingness to perform the pap smear test (p value = 0.008), and between the perceived barriers score and the sociodemographic factors: Age (p value = 0.006), educational level (p value = 0.028) and occupation (p value = 0.040), but no association with the economic status was found (p value = 0.378). Conclusion: The detection rate is too low compared to the national target of over 70%. Therefore, more work is needed to reduce perceived barriers to cervical cancer screening by providing education/raising for popular awareness;addressing misconceptions and false beliefs;informing women about the necessity and importance of Pap smear;and health promotion using mass media such as national television, social media, radio, billboards, and newspapers and other print media.

Effect of Family Cohesion on Depression of Chinese College Students in the COVID-19 Pandemic: Chain Mediation Effect of Perceived Social Support and Intentional Self-Regulation

Individuals’perceptions,attitudes,and patterns of getting along with family members are important factors influencing Chinese people’s self-evaluation.The aim of this study was to investigate the effect of family cohesion on depression and the role of perceived social support and intentional self-regulation in this association.A hypothesized model of the association of family cohesion,perceived social support,intentional self-regulation,and depression was examined.A convenience sampling method was used to survey 1,180 college students in Yunnan Province using self-report.Data were collected using the Family Cohesion Scale,the Perceived Social Support Scale,the Intentional Self-Regulation Scale,and the Center for Epidemiological Studies Depression Scale.The findings revealed low to moderate correlation between the variables studied.College students’family cohesion was a negative predictor of their depression.This association was also mediated by the knock-on effect of perceived social support and intentional self-regulation.These findings show how family cohesion affects college students’depressive status.Specifically,these results help demonstrate the importance of family cohesion,perceived social support,and intentional self-regulation in optimizing students’depression,which in turn can promote better psychological states.

The Relationship between Rural Left-Behind Children’s Physical Activity and Hope:The Mediating Effects of Perceived Social Support

It has been confirmed in previous studies that there is a positive correlation between physical activity and hope.In this study,rural left-behind children in China was taken as the participants to investigate the impact of physical activity on hope in rural left-behind children and examine the mediating role of perceived social support in the relationship between physical activity and hope.797 valid copies of the questionnaire were collected from China.Pearson correlation coefficient was employed to analyze the relationship between physical activity and hope;SEM and Bootstrap were used to test the mediating effect of perceived social support.The results show that physical activity can not only directly and positively predict the level of hope in rural leftbehind children but can also predict the level of hope through perceived social support;perceived social support plays a mediating role in the relationship between physical activity and hope.These results highlight the necessity to pay more attention to the physical activity of left-behind children and the possibility to improve the level of hope by increasing their physical activity;at the same time,the acquisition of more material,emotional and psychological support from teachers and guardians is more conducive to improving the sense of hope in left-behind children.These findings can deepen the understanding of the sense of hope in left-behind children,and provide new methods for and enlightenments on improving the level of hope in left-behind children.

Perceived stress and coping capacities among frontline healthcare workers of AIIMS during COVID-19 pandemic:A cross-sectional study

Objective:To assess perceived stress and coping capacity of frontline health workers from AIIMS during COVID-19 pandemic.Methods:This cross-sectional study conducted from May to July 2021 enrolled 694 participants.An online questionnaire based on Google Forms was developed to collect the data.Participants were assessed using the validated Perceived Stress Scale and the Coping Resources Inventory Scale.Results:The age of participants were 27(23-52)years old.The majority of respondents(73.5%)felt moderately stressed.Of the 694 participants,83.0%of the 576 participants had average stress management skills.Sex,marital status,and profession were significantly associated with perceived stress.In addition,marital status and profession were significantly associated with coping capacity.Conclusions:The majority of participants have moderate stress levels and average coping skills.Frontline healthcare workers have to maintain mental and physical health.Achieving this requires early screening and stress management for healthcare workers.

Extension of Goal-Directed Behavior Model for Post-Pandemic Korean Travel Intentions to Alternative Local Destinations: Perceived Risk and Knowledge

Since the outbreak of COVID-19,tourists have been increasingly concerned over various risks of international travel,while knowledge of the pandemic appears to vary significantly.In addition,as travel restrictions continue to impact adversely on international tourism,tourism efforts should be placed more on the domestic markets.Via structural equation modeling,this study unearthed different risk factors impacting Korean travelers’choices of alternative local destinations in the post-pandemic era.In addition,this study extended the goal-directed behavior framework with the acquisition of perceived risk and knowledge of COVID-19,which was proven to hold a sig-nificantly superior explanatory power of tourists’decisions of local alternatives over foreign countries during the COVID-19 pandemic.Furthermore,desire was found to play an imminent mediating role in the conceptual mod-el,maximizing the impact of perceived risk on travel intentions.Henceforth,this research offers meaningful the-oretical implication as thefirst empirical study to deepen the goal-directed behaviour framework with perceived risk and knowledge in the context of post-COVID-19 era.It also serves as insightful knowledge for Korean tour-ism authorities and practitioners to understand local tourists’decision-making processes and tailor effective recovery strategy for domestic tourism.

Relationship between perceived social support and post-traumatic growth in coronavirus disease 2019 patients discharged from the hospital

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has affected mental health and physical health negatively in some individuals.Examining perceived social support and post-traumatic growth(PTG)in COVID-19 patients could facilitate our understanding of how patients maintain their mental health.AIM To examine the relationship between the level of perceived social support and PTG in COVID-19 patients discharged from the hospital.METHODS This descriptive study was carried out between August and September 2022 with patients who were hospitalized due to COVID-19 in a university hospital in Erzurum and who were discharged at least 3 mo prior to the beginning of the study.The study was completed by 196 patients.Study data were collected faceto-face using a personal information form,multidimensional scale of perceived social support and PTG inventory.RESULTS The total mean score of the multidimensional scale of perceived social support was 63.82±15.72.The PTG inventory total mean score was 47.77±19.85.In addition,a direct significant correlation was found between perceived social support in COVID-19 patients and PTG.CONCLUSION The study results showed that perceived social support variables affected PTG significantly.Therefore,it is recommended for healthcare professionals to implement interventions to promote social support from healthcare professionals and the patient’s family and friends.Considering the negative effects of the ongoing COVID-19 pandemic,it is very important and necessary to implement effective public health interventions to promote PTG to reduce mental health problems.

Preventing Health Anxiety:The Role of Self-Evaluation,Sense of Coherence,Self-Rated Health and Perceived Social Support

Background:Components of Self,completed with the perceived social support determine the individual differences in theevaluation of a stressor and the behavioral responses toward it,such as health-related anxiety.The study set as a goal theanalysis of associations between the components of Self,such as self-evaluation,sense of coherence,perceived social support,and reported health-related anxiety in an adult sample.Methods:147 adults from the 18–73 age group(mean age 37.5)voluntarily completed the questionnaire through Qualtrics online platform containing the Short Health Anxiety Inventory,Core Self-Evaluation Scale,Social Support Assessing Scale,and one Health Self-Evaluation Item.Results:ANOVA foundrelevant differences in total scores and subscales’scores of the health anxiety scale depending on the positive self-evaluation.Linear regression shows that the analyzed variables were responsible for the prediction of a higher value on the“Perceivedprobability of becoming ill”subscale in a proportion of 45.6%and for the“Perceived consequence of illness”subscale in aproportion of 20.2%The predictive value of the linear regression model for the total score on the health anxiety scale was46.3%.Our findings show that negative Core Self-Evaluation is linked with perceived health anxiety.Conclusions:Selfevaluation,sense of coherence and perceived social support influence the perceived health and can explain the differences inthe reported health-related anxiety.

Study on the Perceived Value of Zhanjiang Residents to Mangrove Cuisine

Taking mangrove cuisine in Zhanjiang as an example,this paper investigates the residents’perceived value of mangrove cuisine through questionnaire survey.The results show that the overall satisfaction of residents on the mangrove cuisine in Zhanjiang is high.The highest satisfaction of residents on the perceived value of mangrove cuisine is the historical and cultural heritage,and the lowest satisfaction is the local characteristics.The main factor affecting the satisfaction is the utility value.Based on the analysis of the present situation and existing problems of mangrove cuisine resources in Zhanjiang,this paper puts forward some countermeasures and suggestions for the sustainable development of mangrove food in Zhanjiang in terms of strengthening government support,increasing public participation awareness,increasing publicity channels,enhancing popularity and reputation,and paying attention to the inheritance of characteristic food culture.

Mediating Effect of Perceived Organizational Support on the Resilience and Mental Health of ICU Nurses

Objective:To investigate the mediating effect of organizational support on the relationship between resilience and anxiety-depression-stress by researching ICU nurses.Methods:A total of 675 ICU nurses in Shaanxi Province were surveyed using the organizational support scale,the resilience evaluation scale for medical staff,and the Depression-Anxiety-Stress Scale(DASS-21).Results:The resilience of ICU nurses had significant correlation with the level of organizational support(r=0.448,P<0.01),but was negatively correlated with depression(r=-0.238,P<0.001),anxiety(r=-0.287,P<0.01),and stress(r=-0.213,P<0.01);the level of organizational support of ICU nurses was also negatively correlated with depression(r=-0.452,P<0.01),anxiety(r=-0.410,P<0.01),and stress(r=-0.490,P<0.01).The sense of organizational support played a mediating role between the resilience of ICU nurses and their depression-anxiety-stress,the mediating effect accounted for 78%of the total effect.Conclusion:The perceived organizational support and resilience is an important external protective factor for the mental health and ability of ICU nurses.The management departments should continue to pay attention to the mental health of ICU nurses,take effective measures to improve the sense of organizational support and resilience of nurses,and ensure the good mental health of ICU nurses.

Regional Distribution of Perceived Temperatures Estimated by the Human Heat Budget Model (the Klima-Michel Model) in South Korea

The regional distribution of perceived temperatures （PT） for 28 major weather stations in South Korea during the past 22 years （1983-2004） was investigated by employing a human heat budget model, the Klima-Michel model. The frequencies of a cold stress and a heat load by each region were compared. The sensitivity of PT in terms of the input of synoptic meteorological variables were successfully tested. Seogwipo in Jeju Island appears to be the most comfortable city in Korea. Busan also shows a high frequency in the comfortable PT range. The frequency of the thermal comfort in Seoul is similar to that of Daejeon with a relatively low frequency. In this study, inland cities like Daegu and Daejeon had very hot thermal sensations. Low frequencies of hot thermal sensations appeared in coastal cities （e.g., Busan, Incheon, and Seogwipo）. Most of the 28 stations in Korea exhibited a comfort thermal sensation over 40% in its frequency, except for the mountainous regions. The frequency of a heat load is more frequent than that of a cold stress. There are no cities with very cold thermal sensations. In this study, we found the decreasing trend of mortality with an increasing PT. If the PT is over any critical temperature point, however, the mortality rate increases again. The mortality variation with the PT of a station seems to be associated with the latitudinal location of the station, implying that it results from a regional acclimation effect of inhabitants.

Influence of adverse weather on drivers’ perceived risk during car following based on driving simulations

Adverse weather has a considerable impact on the behavior of drivers,which puts vehicles and drivers in hazardous situations that can easily cause traffic accidents.This research examines how drivers'perceived risk changes during car following under different adverse weather conditions by using driving simulation experiment.An expressway road scenario was built in a driving simulator.Eleven types of weather conditions,including clear sky,four levels of fog,four levels of rain and two levels of snow,were designed.Furthermore,to simulate the carfollowing behavior,three car-following situations were designed according to the motion of the lead car.Seven car-following indicators were extracted based on risk homeostasis theory.Then,the entropy weight method was used to integrate the selected indicators into an index to represent the drivers'perceived risk.Multiple linear regression was applied to measure the influence of adverse weather conditions on perceived risk,and the coefficients were considered as indicators.The results demonstrate that both the weather conditions and road type have significant effects on car-following behavior.Drivers'perceived risk tends to increase with the worsening weather conditions.Under conditions of extremely poor visibility,such as heavy dense fog,the measured drivers'perceived risk is low due to the difficulties in vehicle operation and limited visibility.