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The pervasive penetration of social media is reshaping the generative logic and communication pathways of health anxiety, which is significantly impacting public mental health and individual behavior. This study aimed to examine the topic threads of health anxiety discussions on Sina Weibo as well as the threat and efficacy elements contained in the health-related messages through the Extended Parallel Process Model (EPPM) framework. A total of 138,587 social media posts related to health anxiety were collected using keyword combination of "health" AND ("worry" OR "concern" OR "anxiety") on the Weibo open API. Latent Dirichlet Allocation (LDA) model procedures were applied to identify the main topics in health anxiety discussions. Moreover, 1,480 most popular posts ranked by "Like" clicks were selected for manual textual analysis. Based on the Extended Parallel Process Model (EPPM), four dimensions-severity, susceptibility, self-efficacy, and response efficacy-were used as the coding framework for content analysis to systematically ascertain the topic structure, information characteristics and information engagement with health anxiety Weibo discussions. Discussions of health anxiety cover a wide range of topics. The most prominent topic is positive living and health ideals (intensity = 0.4456), and other major topics include sleep disorders and mental health, adolescent mental health education and social adaptation, healthy lifestyle and self-management. There is a noticeable imbalance between elements of threat and efficacy in health anxiety discussions. Threat information dominates health anxiety discussions, with severity being the most prevalent component (73.24%). Conversely, efficacy information is much less featured, particularly regarding response efficacy (16.15%). Higher perceived threat levels in health anxiety discussions correlate with reduced engagement (fewer likes), whereas greater efficacy information levels are associated with increased engagement (more likes). Health anxiety discussions on social media exhibit a generative logic characterized by thematic threads emphasizing positive confidence-building, proactive measures, ailment-specific guidance, and subgroup-focused solution tips. Users' conception of health anxiety reflects a contradictory pattern of "high threat-low efficacy", wherein information about health threats is far more prevalent than information about self-efficacy. These findings show that EPPM-related threat and efficacy elements are distributed in user-generated Weibo discussions.
Suicide and suicidal behavior in the Gulf Cooperation Council (GCC) countries remain underrepresented in empirical research, largely due to cultural stigma, legal prohibitions, and systematic underreporting. The behavioral and sociocultural determinants of suicidal behavior in these contexts-where rapid modernization intersects with Islamic normative frameworks and large-scale labor migration-have received particularly limited systematic attention. This review synthesizes available evidence on the prevalence, behavioral patterns, risk factors, and structural determinants of suicidal behavior across Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Following PRISMA 2020 guidelines, we searched PubMed, Scopus, ScienceDirect, Web of Science, and Google Scholar for primary research published between 2000 and 2025. Fifty studies (34 GCC-specific and 16 contextual/comparative) met the inclusion criteria. Methodological quality was appraised using the Newcastle-Ottawa Scale, JBI checklists, the Mixed Methods Appraisal Tool, and the AACODS checklist. The review protocol was registered on the Open Science Framework (DOI: 10.17605/OSF.IO/RZXY7; URL: https://osf.io/rzxy7/). The findings were organized into six dimensions: (1) suicide prevalence, risk factors, and associated behaviors; (2) cultural and religious influences; (3) mental health of specific at-risk populations; (4) healthcare and support services; (5) migrant worker vulnerabilities; and (6) research trends. Reported suicide rates in the GCC range from 1.5 to 4.2 per 100,000 but likely underestimate the true prevalence due to forensic misclassification and stigma. Migrant workers constitute a high-risk subgroup, with suicidal ideation reaching 68% among those facing acute financial distress. Islamic religiosity is associated with lower suicide mortality but simultaneously deters help-seeking by stigmatizing mental distress. Interpreted through a Durkheimian lens, these findings position suicidal behavior in the GCC as a social fact shaped by weakened social integration and normative fragmentation under rapid modernization. Effective prevention requires culturally adapted behavioral interventions that integrate labor welfare reforms with community-based mental health strategies.
Online health information seeking (OHIS) can support self-management and health decision-making among older adults, yet many still face barriers to digital health engagement. Perceived declines in information processing speed may constrain older adults' ability and motivation to seek health information online, but the potential explanatory pathways and contextual conditions remain insufficiently understood. This study examined the associations between perceived information processing speed decline and older adults' OHIS, with a focus on the roles of self-efficacy, outcome expectations, and community IT culture. A cross-sectional survey was conducted among 295 adults aged 60 years and older. Data were collected using a structured questionnaire and analyzed with partial least squares structural equation modeling to test the proposed research model. Perceived declines in information processing speed were negatively associated with self-efficacy but were not directly associated with outcome expectations or online health information seeking. Self-efficacy was positively associated with outcome expectations, and outcome expectations were positively associated with online health information seeking. Community IT culture moderated the association between perceived declines in information processing speed and self-efficacy, such that the negative association was weaker among older adults reporting stronger community IT culture. Bootstrapping further showed a significant sequential indirect association linking perceived declines in information processing speed to online health information seeking through self-efficacy and outcome expectations. Perceived declines in information processing speed were indirectly associated with online health information seeking through motivational beliefs rather than through a direct pathway. A supportive community IT culture may buffer the negative association between perceived processing speed decline and self-efficacy. These findings highlight the importance of strengthening self-efficacy and outcome expectations while fostering supportive community-level digital environments to promote digital health engagement among older adults.
Early childhood is a critical period for children's growth and development. Given that over 30% of Thai children under age five experience developmental delays, it is important to examine their movement behavior: physical activity, sedentary behavior, and sleep. These three components are important factors for optimal development. This study assessed 24-h movement behaviors of Thai preschoolers, determined the proportion meeting WHO guidelines, and explored how demographic factors differentiate these behaviors. Data from the Sunrise Thailand Dataset 2023, comprising 518 children aged 3-4 years (50.5% boys and 49.5% girls), were analyzed. Physical activity, sedentary behavior, and sleep were measured using ActiGraph GT3X + accelerometers. Children's adherence to WHO guidelines was evaluated using descriptive statistics. Independent-samples t-tests and one-way ANOVAs examined differences across demographic subgroups. Multiple linear regression models identified predictors of movement behaviors. Only 26.3% of Thai preschoolers met recommended physical activity levels, 49.8% adhered to sleep duration guidelines, and 68.5% followed sedentary behavior limits. Just 7.5% met all three recommendations simultaneously. Regression analyses revealed socioeconomic factors as the strongest predictors: children from low-income households and those with parents in agriculture or government sectors showed significantly reduced sleep duration and increased sedentary time. Single-parent families demonstrated the lowest overall adherence. The majority of Thai preschoolers failed to meet WHO guidelines, with particularly low compliance in physical activity. These results emphasize the need for developing public health strategies to improve movement behavior, especially in vulnerable populations such as single-parent families and rural communities. Policies should focus on increasing access to safe play environments, promoting active lifestyles, and providing targeted support to caregivers to help children meet these critical health recommendations.
Achieving and maintaining weight loss are challenging and require sustained lifestyle changes. This study examined which behavior change techniques (BCTs) support long-term weight outcomes among adults with overweight or obesity. We synthesized evidence from randomized controlled trials of behavioral interventions versus control or alternative interventions, focusing on nonclinical adults (BMI > 25) with ≥ 6-month follow-up, published between 2010 and 2025, that reported weight outcomes. Sixty-five studies (approximately 10,000 participants) evaluating 87 behavioral interventions targeting physical activity, diet, or both were included. BCTs were coded using the BCT Taxonomy v1. Meta-analysis estimated pooled effects on total weight loss (baseline to follow-up) and weight maintenance (posttreatment to follow-up). Behavioral interventions produced a mean effect size for total weight loss of Hedges' g = -0.19 (95% CI = -0.30 to -0.13), equating to an average additional weight loss of approximately 3.25 kg compared to controls. No significant effect was found for weight maintenance after initial loss, indicating no statistically significant difference in weight change between intervention and control groups during follow-up. Meta-regression examined the number of BCTs, intervention type, and follow-up duration, but none significantly moderated effects. Subgroup analyses identified the following effective BCTs: goal setting, feedback on behavior and outcome(s) of behavior, self-monitoring of behavior and outcome(s) of behavior, instruction on how to perform the behavior, demonstration of the behavior, conserving mental resources and incentives. These BCTs appear to support relative long-term weight outcomes and warrant further investigation.
Picky eating is common among children with autism spectrum disorder (ASD). However, the specific effects of different levels of picky eating on nutritional status, dietary diversity, and eating behaviors in preschool-aged children with ASD remain unclear. This study aimed to compare these aspects between children with low versus high levels of picky eating. A cross-sectional study design was employed, enrolling 130 children with ASD aged 3 to 6 years who met the DSM-5 diagnostic criteria [Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-V)]. Trained personnel measured each child's height and weight using standardized instruments. Validated dietary diversity scores and preschool eating behavior scales were used to assess dietary diversity and nutrient intake and eating behaviors. energy and macronutrient intake were quantified through three non-consecutive 24-hour dietary recalls. Children were divided into a low picky eating group and a high picky eating group based on the degree of picky eating for comparative analysis. There were no statistically significant differences in height and weight indicators between the two groups, with most children falling within the normal range of growth and development. However, distinct differences were observed in nutrient intake and eating behaviors: children in the low picky eating group showed significantly higher total dietary diversity scores (P<0.05). Regarding nutrient intake, children in the low picky eating group exhibited higher intake levels of total energy, polyunsaturated fatty acids, and dietary fiber compared to those in the high picky eating group; in specific food categories, intake of starchy tubers, fruits, nuts, and legumes was also significantly higher. Regarding eating behaviors, children in the low picky eating group showed lower scores for picky eating and problematic eating behaviors, whereas exhibited heightened satiety responsiveness, with all differences reaching statistical significance (P<0.05). The degree of picky eating is a key factor influencing dietary quality and eating behaviors in preschool-age children with ASD. Low levels of picky eating are associated with more comprehensive nutrient intake, richer dietary diversity, and more favorable eating behavior patterns. Early identification and intervention targeting picky eating behavior are of significant importance for improving the nutritional status of children with ASD.
Transgender and gender-diverse (TGD) individuals, whose well-being relies on gender-affirming care, faced heightened barriers during the COVID-19 pandemic. Structural inequities intensified as non-emergent services were deprioritized. In this paper we examined changes and delays in healthcare access by TGD populations across the United States during the COVID-19 pandemic. From September 2022 through March 2023, we administered an online survey to TGD adults in the United States. Participants responded to the question, "How did COVID-19 impact your experience accessing healthcare?" We used inductive coding and thematic analysis techniques to analyze the 87 responses. Response themes were: (1) shift to telehealth, (2) availability and access and why those were limited, (3) affordability, (4) delays in gender-affirming care, and (5) delays in healthcare overall. Participants frequently discussed telehealth shifts and access limitations. TGD individuals face significant, structurally rooted healthcare barriers that COVID-19 intensified. Integrating gender-affirming care into comprehensive healthcare systems is essential for ensuring accessible care for TGD populations. Additionally, creating and reforming relevant policies with input from TGD individuals can help reduce healthcare access disparities going forward and in future crises.
Breast self-examination (BSE) is a simple, low-cost method for promoting breast awareness and early detection of breast abnormalities, particularly among young women. However, lack of confidence and perceived barriers often limit regular BSE practice. Educational interventions that combine theoretical knowledge with hands-on training may enhance self-efficacy and support sustainable behavioral change. This study aimed to compare the effects of theoretical education alone versus theoretical plus hands-on BSE training on breast cancer knowledge, health beliefs, and BSE practice among female university students. This randomized controlled study was conducted among 40 female university students residing in university dormitories. Participants were stratified based on pretest scores and randomly assigned to either a theoretical education-only group (n = 20) or a theoretical plus hands-on training group (n = 20). The primary outcomes were breast cancer knowledge, health beliefs, and BSE practice. Breast cancer knowledge was assessed at baseline, immediately after training, and at a 3-month follow-up using the Breast Cancer Knowledge Test (BCKT). Health beliefs were assessed at baseline and at the 3-month follow-up using the Champion Health Belief Model Scale. BSE practice frequency and perceived barriers were also recorded. Repeated-measures and mixed-design ANOVA and chi-square tests were used for data analysis. Breast cancer knowledge increased significantly in all participants from pretest to posttest (p < 0.001) and remained significantly higher than baseline at the 3-month follow-up, although a slight decline was observed. No significant Time × Group interaction was found for knowledge scores. In contrast, significant Time × Group interactions were observed for health motivation (p = 0.001), perceived barriers to BSE (p < 0.001), and self-efficacy (p = 0.005), all favoring the theoretical plus hands-on training group. Regular BSE practice increased from 0% at baseline to 60% at follow-up across the cohort, with a significantly greater increase in the hands-on training group compared with the theoretical-only group (75% vs. 45%, p = 0.038). While theoretical education effectively improves breast cancer knowledge, the addition of hands-on BSE training is critical for reducing perceived barriers, enhancing self-efficacy, and promoting regular BSE practice. Incorporating hands-on training into breast health education programs may substantially improve behavioral outcomes among young women.
Adolescence is a critical period where growing autonomy over food choices shapes long-term health behaviors. While stress and dietary restriction are linked to eating behavior, prior research has examined trait-level stress, leaving momentary processes less understood. This study investigated associations between momentary perceived stress and eating behaviors, with dietary restriction tested as a moderator. Participants (N = 74 ages 14-17) from Los Angeles County completed a 10-day ecological momentary assessment protocol that included three to seven random smartphone prompts per day and initiated additional prompts during eating episodes. Perceived stress and dietary restriction were assessed at random prompts, while eating behaviors were assessed during eating-episode prompts. Eating behavior outcomes included dysregulated eating (loss of control eating and overeating) and food consumed (pastries/sweets and fruits/vegetables). Time-lagged generalized linear mixed models tested within- and between-subjects associations. Neither within-subject perceived stress nor its interaction with restriction significantly predicted outcomes. No associations were found for predicting fruit and vegetable nor pastry/sweet consumption. However, in the main effect model, greater within- and between-subjects dietary restriction predicted subsequent loss of control eating, and higher between-subjects restriction predicted increased pastry/sweet intake. The findings highlight dietary restriction as a key acute predictor of adolescents' loss of control eating, whereas momentary perceived stress did not emerge as a precipitant. Findings underscore the importance of screening for restrictive eating patterns and suggest that pediatricians and caregivers should monitor adolescents at risk. Future research should refine momentary stress assessment and test potential moderators of associations.
This study examined how mental healthcare providers' characteristics (e.g., firearm ownership) impact whether they screen for firearm access, and differences in reported screening frequency across clients' clinical presentations and demographics. The sample included 311 mental healthcare providers (data collected 2023-2024). Providers indicated whether they screen for firearm access in their practice (yes/no), and those who responded yes (n = 227) then rated how often they screen clients with a variety of characteristics from 1 (Never) to 5 (All the Time). Providers who own firearms (n = 53) were more likely to report firearm access screening in their current practice, yet they also endorsed greater perceived barriers to screening (e.g., beliefs that screening would not reduce injury/death) than non-firearm owning providers. Providers who reported screening more often did so based on a client's reported suicidal behaviors/attempts compared to ideation; providers were also more likely to screen males than females. No differences were reported between clients who experience homicidal thoughts and behaviors/attempts or across age and racial/ethnic identity. Overall, mental healthcare providers more frequently screen males and those with suicidal behaviors/attempts for firearm access. Firearm-owning providers endorsed higher perceived barriers despite screening more frequently, highlighting the complexity of factors influencing screening practices. The demographics of firearm owners are changing, and there is an increased risk of firearm-related violence for the household when a firearm is in the home. Further training and resources for mental healthcare providers are needed to broaden firearm access screening beyond specific contexts.
Transitions to a new educational ecosystem result in students' academic distress, particularly at the university level. Thus, this study aimed to examine academic distress and help-seeking practices among first-year domestic and international university students in the fields of Engineering and Health Sciences. The study mainly focused on academic distress and help- seeking behavior abided by the help-seeking process model and mind sponge mechanism. A quantitative correlational research design was used. A total of 361 students were selectedusing simple random sampling. Standardized questionnaires were used to measure the variables. Descriptive statistics and Multivariate Analysis of Variance (MANOVA) were used to achieve the study objectives. The results revealed that University students had moderate levels of help-seeking behavior and academic distress. Moreover, male students had higher academic help-seeking behavior and lower academic distress than their female counterparts; whereas academic help-seeking behavior and academic distress were lower for female students. Statistically significant sex differences were also noted in academic distress. Based on the mind sponge theory, measures for the prevention of academic distress should be targeted at the optimization of help-seeking behavior with a special focus on female students who manifest a high vulnerability to academic distress. Moreover, ways such as digital-based interventions that assist in addressing a large number of students at once also merit attention.
The participation of patient in this task can be done with the help of certain indicators such as the oral health related quality of life (OHRQOL). This indicator helps to measure the extent to which oral health conditions impact on a patient's behavior and social functioning. Oral health-related quality of life (OHRQOL) serves as a measure to assess the impact of oral health on the overall well-being of individuals. Good oral health improves quality of life, necessary to improve an individual productivity in life. Therefore the aim of this study was to evaluate the effect of dental caries on OHRQOL in adults in Ebolowa, Cameroon. This cross‑sectional study was conducted in people aged over 15 years living in Ebolowa, South of Cameroon. Data collection was conducted from October 2022 to May 2023. Patients and their attendees (e.g., patients' family members and relatives) visiting the outpatient department of the dental unit were selected. Patients who were fifteen years old or more, and were residents of Ebolowa and its surroundings were included in the study. A simple random sampling technique was adopted for the current study. The majority of participants (54.37%) were found to be in the 'High' risk category, 17.48% in the 'moderate' category and only 28.16% in the 'low' risk category. Concerning dental caries, 17.15% of the study population had a score equal to or above the SiC index. Dental caries affects OHRQOL in adults. Using OHRQoL as an assessment tool, along with a dental clinical indicator, can be beneficial in planning oral health programs.
There is much excitement about the potential for dementia prevention by targeting modifiable risk factors, yet sociodemographic disparities in dementia-related knowledge, stigma, and risk factor awareness remain underexplored. This study examines these differences among minoritised ethnic communities in the UK. As part of a project by the NIHR Dementia and Neurodegeneration Policy Research Unit at Queen Mary (DeNPRU-QM), dementia knowledge, stigma, and risk factor awareness of 3500 participants were assessed in a secondary analysis of data from two national surveys conducted in 2023 by Alzheimer's Research UK. Linear regression models were used to examine associations between ethnicity and knowledge-related outcomes, while ordinal logistic regression was used for stigma, adjusting for age, sex, education, social grade, chronic conditions, and knowing someone with dementia. Compared to White participants, South Asian (Coef. = -0.45, 95% CI [-0.55, -0.34], p < 0.001) and Black participants (Coef. = -0.17, 95% CI [-0.27, -0.06], p < 0.005) had lower knowledge about dementia. Compared to White participants, Black participants had higher odds of reporting greater stigma (OR = 2.55, 95% CI [2.10, 3.09], p < 0.001), as did South Asian participants (OR = 1.62, 95% CI [1.34, 1.97], p < 0.001) and participants from Other ethnic groups (OR = 1.55, 95% CI [1.17, 2.07], p = 0.003). Black individuals also had lower knowledge of dementia risk factors compared to White participants (Coef. = -0.655, 95% CI [-1.110, -0.200], p = 0.005). Education level, chronic health conditions, gender, profession, and knowing someone with dementia were also associated with some outcomes, although associations varied by outcome. Ethnic disparities exist in dementia knowledge, stigma, and dementia risk factor awareness. Any future public information campaign around dementia risk reduction and timely diagnosis should ensure cultural competency and include strategies to reach minoritised ethnic communities. Policymakers should consider how prevention might be promoted in all health and social care encounters, since people with chronic conditions who may not be eligible for primary health checks had lower levels of knowledge about dementia.
Although device-measured data provide more reliable estimates of movement behaviors than self-report questionnaires, device-monitoring protocols are often demanding in terms of time, logistics, and costs. Identifying the minimum monitoring duration to obtain reliable data is therefore essential, yet evidence for ActivPAL devices remains limited. The objective of this study was to determine the minimum number of days required to reliably estimate movement behaviors using ActivPAL. As a secondary aim, we examined how different combinations of weekdays and weekend days influence reliability. A total of 106 monitoring periods of six consecutive days from adult office workers were analyzed, corresponding to 636 monitored days or 15 264 h collected. Taking the 6-day period as reference, the reliability of shorter monitoring durations (1-5 days) was assessed. Relative and absolute reliability were confirmed when an intraclass correlation coefficient ≥ 0.85 and a coefficient of variation < 10% were achieved, respectively. Movement behaviors assessed included stepping time, standing time, sedentary time, sitting time, primary lying time, step count, and sit-to-stand transitions. Based on these criteria, two monitoring days were sufficient to achieve both relative and absolute reliability for sit-to-stand transitions, while 3 days were sufficient for sedentary time, sitting time, and primary lying time. Four days were required to achieve comparable reliability for stepping time, standing time, and step count. Overall, monitoring periods that combined weekdays and weekend days tended to demonstrate higher reliability than those including only weekdays or weekend days. These findings may guide optimization of ActivPAL monitoring protocols, reducing participant and researcher burden while maintaining reliable movement behavior estimates.
To assess adults' knowledge, attitudes, and behaviors about cancer screening in primary care, and to evaluate short-term changes in attitudes after brief written information. This cross-sectional study was conducted from March to June 2019 in a family medicine outpatient clinic. Adults aged 20-70 years who agreed to participate were consecutively enrolled. Data were collected using a structured face-to-face questionnaire assessing sociodemographic characteristics, cancer screening awareness, prior screening behavior, barriers, and post-brochure attitudes. Because study participation age did not necessarily correspond to screening eligibility, a post hoc binary screening-eligibility variable was created according to the study-period age/sex framework reflected in the questionnaire and source dataset. Categorical variables were analysed using Pearson's chi-square test or Fisher's exact test, as appropriate, and paired pre/post willingness responses were analysed using McNemar's exact test. Exploratory multiple binary logistic regression was performed for prior screening uptake. A total of 247 participants were included (mean age 43.4 ± 12.7 years; 68.4% female). Overall, 40.5% were aware of cancer screening tests and 37.0% reported having previously undergone at least one screening test. However, uptake differed markedly by screening eligibility: 89/169 (52.7%) eligible participants versus 2/77 (2.6%) non-eligible participants had ever been screened. Awareness distribution differed significantly between healthcare workers and non-healthcare participants, whereas crude prior screening uptake did not differ significantly by occupation. Willingness to undergo screening increased after the brochure, indicating a short-term positive change in intention. Awareness of cancer screening did not consistently translate into screening participation. Crude non-screening rates should not be interpreted without considering screening eligibility structure and sample composition. Brief written information may improve short-term willingness, but these findings should be interpreted as intention rather than confirmed behavioral change.
Despite the recognition of substance use and sex work as public health issues, the intersection of these areas, especially within the rural US, is an area of special importance. The Rural Opioid Initiative comprises of eight research cohorts spanning 10 states and 65 rural US counties. Between 1/2018-3/2020, individuals who reported past 30-day substance injection or opioid misuse were recruited. Analyses were restricted to people who use drugs (PWUD) who reported trading "vaginal or anal sex for drugs, money, housing, or other things you need" in the past 30 days. We analyzed cross-sectional associations between injection drug use and sexual behaviors associated with hepatitis C virus (HCV)/HIV infection transmission, access to harm reduction, and HCV status among PWUD and engaged in sex work in rural US areas. Of the 2045 participants, 9% (n=180) reported engagement with sex work, with just over half being women (58% [n=104]). In adjusted models, people who engaged in sex work, compared to PWUD who did not, had higher prevalence ratios of past 30-day receptive syringe sharing (adjusted prevalence ratio [aPR]=1.69, 95% Confidence Interval [95%CI]=1.44-1.98), practice of multiple injections per injection episode (aPR = 1.28, 95% CI = 1.15-1.43), practice of syringe mediated drug sharing (aPR=1.50, 95% CI=1.32-1.71), condomless sex (aPR=1.62, 95% CI=1.48-1.77) and condomless sex with someone who injects drugs (aPR=2.05, 95% CI=1.76-2.39). PWUD engaged in sex work were less likely to report easy condom access (aPR=0.88, 95% CI=0.80-0.96), while no significant differences were observed for most other harm reduction access measures. PWUD engaged in sex work in the rural US had higher likelihood of injection drug use and sexual behaviors associated with HCV/HIV infection transmission, while having lower use of and access to condoms. This study emphasizes the importance of ensuring affordable access to condoms within the context of harm reduction services, especially given the limited access to health care and supportive services, particularly in rural communities.
Falls remain a major patient safety concern among hospitalized older adults, particularly as previously independent individuals become acutely vulnerable during admission. Although falls prevention strategies are widely used, their implementation is often insufficiently patient-centered and may not reflect the cultural, linguistic, and organizational realities of healthcare settings in the United Arab Emirates (UAE). This study explored fall risk and prevention from the perspectives of hospitalized older adults, frontline healthcare professionals, and nurse managers in the UAE. A qualitative descriptive study was conducted across two acute care hospitals in the UAE. Using purposive sampling, data were collected in two phases: semi-structured interviews with hospitalized older adults aged ≥65 years (n=8); focus group discussions with nurses and allied health professionals (n=12); and nurse managers (n=15). Data was analyzed thematically, and triangulation was used to identify converging patterns across stakeholder groups. Four themes were identified: (1) autonomy versus safety, (2) gaps in patient education and engagement, (3) system and environmental barriers, and (4) opportunities for innovation and patient-centered solutions. Patients often prioritized independence despite clinical vulnerability, while staff highlighted limitations in education, delayed responses to call bells, environmental hazards, and the reduced sensitivity of current risk assessment processes to dynamic clinical change. Participants across groups emphasized the need for culturally responsive education, clearer communication, and more integrated system-level approaches. Fall risk in hospitalized older adults is shaped by the interaction of patient behavior, communication practices, environmental conditions, and organizational responsiveness. This study contributes context-specific evidence from the UAE, showing that falls prevention should move beyond standardized risk scoring toward patient-centered, culturally responsive, and system-integrated strategies. Future research should examine whether addressing these barriers improves measurable outcomes such as fall rates, reassessment compliance, and response times.
Adaptive functioning typically aligns with cognitive ability in the general population, but this relationship appears more complex in neurodivergent populations. Individuals with autism, attention-deficit/hyperactivity disorder (ADHD), and obsessive-compulsive disorder (OCD) frequently show a discrepancy between cognitive ability and adaptive functioning. However, the behavioral and sociodemographic factors associated with this cognitive-adaptive functioning gap remain unclear. Data were collected from the Province of Ontario Neurodevelopmental Disorders Network (POND) and included 902 participants aged 6-21 years (autism = 409, ADHD = 210, OCD = 36, neurotypical = 214, other = 33). Cognitive functioning was assessed using full-scale IQ from the Wechsler tests, and adaptive functioning using the Adaptive Behavior Assessment System-II (General Adaptive Composite). The cognitive-adaptive functioning gap was calculated as the difference between FSIQ and ABAS-II GAC scores. This gap was modeled transdiagnostically with phenotypic (social communication, ADHD and OCD traits, internalizing and externalizing symptoms) and sociodemographic (age, sex, race, household income, caregiver education) features. Three classifiers (i.e. logistic regression, CatBoost, and Explainable Boosting Machine) were trained to distinguish children with above- versus below-median cognitive-adaptive functioning gap scores. Feature importance was assessed for the selected model using SHAP values. Sensitivity analyses repeated the performance analysis and feature-importance assessment using a 15-point FSIQ-ABAS GAC gap threshold and a continuous-outcome model of the numerical FSIQ-ABAS GAC gap. Logistic regression, CatBoost, and Explainable Boosting Machine models showed comparable performance (ROC-AUC = 0.698-0.700). CatBoost was selected for SHAP-based interpretation because it achieved competitive performance and allowed efficient tree-based SHAP estimation. SHAP analysis identified internalizing problems, social communication challenges, and OCD symptoms as the strongest predictors. Behavioral factors contributed more to the gap than sociodemographic variables. Sensitivity analyses using a 15-point gap threshold and a continuous gap outcome retained the same core behavioral contributors: internalizing problems, social communication challenges, and OCD symptoms. Internalizing symptoms and social communication difficulties were most strongly associated with the cognitive-adaptive functioning gap.
Adverse childhood experiences (ACEs) and social determinants of health (SDOH) are associated with increased risk of neurodevelopmental conditions (i.e. Attention-Deficit/Hyperactivity Disorder [ADHD]). Yet, limited research characterizes the presence of these factors in adults seeking evaluation. This exploratory study used latent profile analysis to examine ACE/SDOH phenotypes in 273 adult patients referred for neuropsychological evaluation to rule out ADHD. We identified five profiles: "minimal distress," "sexual abuse," "higher abuse/neglect/ACEs," "moderate abuse/neglect/ACEs," and "academic/social problems," with excellent class separation. Further characterizing ACE/SDOH phenotypes may be critically important for contextualizing neuropsychological findings; however, future research that includes additional indicators of SDOH is needed.
Acute low back pain is a prevalent musculoskeletal disorder that can disrupt motor control and compromise functional stability. Evidence suggests that pain alters motor unit discharge characteristics and the temporal organization of muscle activation; however, the specific neuromuscular adaptations associated with acute low back pain remain insufficiently understood. This study aimed to investigate the effects of experimentally induced acute low back pain on force steadiness and motor unit discharge characteristics (including recruitment threshold, motor unit firing rate, and action potential amplitude) during a sustained spinal extension task METHODS: Thirty-three healthy participants (aged 18-40 years) performed a sustained spinal extension task at 20% of their maximum voluntary contraction under two experimental conditions: pre- and during pain induced by hypertonic saline injection, and pre- and during-isotonic saline injection into the right lumbar region. Electromyography signals were recorded bilaterally from the longissimus muscles. Signals were decomposed into individual motor unit action potential trains using advanced algorithms and clustered using the K-means method. The hypertonic saline injection successfully induced moderate pain on the numerical pain rating scale (NPRS) (median = 4.71; interquartile range (IQR) = 1.61), which was significantly higher than the isotonic control condition (NPRS median = 1.50; IQR = 1.00; p < 0.001). During the pain condition, significant lateralized adaptations were observed: motor units within the contralateral (left) longissimus muscle exhibited an increased firing rate (p = 0.020, r = 0.33), with no significant changes in the recruitment threshold or motor unit action potential amplitude. On the ipsilateral side, subtle modulations in recruitment threshold were detected. In contrast, the isotonic condition elicited only localized and nonsystemic neuromuscular changes, without the coordinated bilateral organization observed under acute pain. Acute low back pain induces a dynamic and lateralized modulation of motor unit recruitment, suggesting a compensatory redistribution of neural drive that may help preserve functional stability despite altered motor coordination. These findings provide novel insights into the neuromuscular adaptations underlying acute low back pain and have potential implications for physiotherapy assessment and intervention.