Sleep problems are common among university students and are associated with lifestyle behaviors, health status, and overall wellbeing. Examining factors associated with sleep quality in teacher education students may provide valuable insights into student wellbeing and sleep-related health risks. This study examined whether health behaviors, self-rated health, and objectively measured cardiorespiratory fitness predict sleep quality among teacher education students. A total of 228 students completed the Pittsburgh Sleep Quality Index (PSQI) and a questionnaire assessing alcohol consumption, cigarette and energy drink use, body mass index, and self-rated health. Cardiorespiratory fitness was assessed using the 20-metre shuttle run test. Participants were classified as good or poor sleepers using the standard PSQI cut-off (>5). Hierarchical logistic regression was conducted in three steps: Model 1 included age, sex, and relationship status, Model 2 added health and health-related variables, and Model 3 included VO₂max. Poor sleep quality was reported by 36.4% of students. In hierarchical logistic regression analysis, self-rated health was the only significant predictor of poor sleep quality. Compared with students reporting very good or excellent health, those reporting good health (OR = 2.91; 95% CI: 1.54-5.47; p < 0.001) and poor/very poor health (OR = 3.16; 95% CI: 1.02-9.76; p = 0.046) had higher odds of poor sleep quality. Cardiorespiratory fitness (VO₂max) was not independently associated with sleep quality in the final regression model. The final model demonstrated modest explanatory power (Nagelkerke R 2 = 0.120). Self-rated health showed the most consistent association with sleep quality among teacher education students, suggesting that students' perceptions of their overall health may serve as a simple indicator of wellbeing in this population.
The college environment presents various academic and life pressures that affect students' mental health. Previous studies have examined self-compassion, perceived stress, and adverse childhood experiences separately, but few have integrated them within a unified resilience framework. Drawing on the stress-buffering theory, this study aims to examine the relationships among self-compassion, ACEs, perceived stress, and mental health, and to investigate the mediating role of resilience. The study develops an integrative framework that simultaneously considers risk and protective psychological mechanisms, thereby extending previous research by examining the mediating role of resilience in the associations of early adversity, stress perception, and self-compassion with mental health among university students. This cross-sectional study employed an online self-report survey conducted via the Questionnaire Star platform (www.Sojump.com). Using a convenience sampling method, college students from two universities in China completed the Self-Compassion Scale, Adverse Childhood Experiences Scale, Perceived Stress Scale, Resilience Scale, and Mental Health Scale. A total of 657 valid questionnaires were obtained. Correlations among variables were analyzed using SPSS Statistics 26, and mediation effects were tested with Model 4 of the PROCESS 4.0 macro. Self-compassion was positively associated with mental health, while adverse childhood experiences and perceived stress were negatively associated with mental health. Resilience played a mediating role, linking these factors to mental health outcomes. This study underscores the importance of resilience in mental health and provides a theoretical basis for interventions in higher education, emphasizing resilience enhancement to support student well-being.
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.
Mobile health (mHealth) interventions with virtual coaches offer scalable and potentially cost-effective solutions for health behavior change. However, these interventions commonly present challenges, such as limited personalization and insufficient grounding in evidence-based strategies. Perfect Fit (PF; Perfect Fit consortium), a personalized mHealth intervention with a text-based virtual coach, supports adults in quitting smoking and becoming more physically active. By combining innovative techniques, including sensor technology, end user involvement, and evidence-based strategies, PF aims to address common challenges faced by mHealth interventions, including those with virtual coaches. The study primarily investigated the feasibility and acceptability of PF. The secondary aim was to explore associations between sociodemographic, smoking-, and physical activity-related characteristics and the feasibility and acceptability outcomes. The third aim was to evaluate the feasibility of conducting the research study. A single-arm, pre-post, mixed methods study was conducted in the Netherlands with 100 adults who smoked. The intervention lasted approximately 16 weeks. Data were collected at baseline, during the intervention, and postintervention (4 months). Quantitative data included usage data and self-report questionnaires on feasibility, acceptability, and baseline characteristics. Qualitative data were gathered through postintervention semistructured interviews. Analyses included descriptive and inferential analyses, as well as the framework approach for the qualitative data. PF usage varied considerably across participants (n=87). The mean satisfaction rating was 2.79 (SD 0.73; scale range 1-4), and perceived usability had a median score of 67.50 (range 12.50-87.50; scoring range 0-100), indicating OK-to-good usability. The mean virtual coach acceptance rating was -0.27 (SD 1.30; scale range -3 to 3; n=77). Higher PF usage was associated with greater satisfaction, usability, and coach acceptance (all P≤.004). Frequent connection issues with the smartwatch were a disruptive factor. Qualitative findings (n=12) provided in-depth insights into PF's feasibility and acceptability, encompassing both positive and negative experiences. For instance, some participants valued the virtual coach for its anonymity, low-threshold access, and the sense of control it offered, while others preferred a human coach for greater accountability. Suggested improvements included more varied content and enhanced adaptability of the coach to users' input and personal situations. Exploratory analyses suggested that high PF users were older than moderate (P=.01) and low PF users (P=.05). Importantly, PF was perceived as similarly feasible and acceptable across socioeconomic groups (P>.05), aligning with one of the project's goals. Finally, research procedures and recruitment strategies proved feasible. PF shows potential as an accessible and inclusive strategy for multiple health behavior changes, contributing to public health. Findings highlight areas for improvement and can guide the future development of virtual coach interventions.
Firearms are the leading cause of death among children in the United States (US). As of 2023, half of US states had enacted laws allowing permitless concealed carry of firearms. Our cross-sectional study evaluated the association between permitless concealed carry laws and child general health using data from the nationwide Environmental influences on Child Health Outcomes (ECHO) Cohort collected between 2003 and 2023. Children aged 1-21 years with caregiver- or self-reported general health status were included. Secondary outcomes included child internalizing and externalizing behaviors and child stress. Regression models estimated the association of exposure to state-level permitless concealed carry laws six months prior to each outcome, adjusted for individual- and area-level covariates. One-fifth (20.9%) of the sample (n = 11,325) lived in states allowing permitless concealed carry of a handgun. Children living in these states were 25% less likely (OR: 0.75, 95% CI: 0.60, 0.95) to report excellent/very good general health and had psychological stress scores 0.21 standard deviations higher (β = 0.21, 95% CI: 0.10, 0.31) than children in other states. There was no statistically significant association with internalizing or externalizing behavior scores. Our study found that children living in states that allow permitless concealed carry of firearms had worse general health and higher stress, suggesting the need for policy changes to address gun violence as a public health and human rights crisis.
Social determinants of health (SDoH) are the non-medical factors that influence an individual's health and well-being. This study aimed to examine the relationships between SDoH and post-concussion symptom severity in Canadian children. We conducted a secondary analysis of data collected through Advancing Concussion Assessment in Pediatrics (A-CAP), a prospective longitudinal cohort study. Children aged 8-16 years with concussion (n = 633) or orthopedic injury (OI; n = 334) were recruited from five Canadian pediatric emergency departments. Post-concussion symptoms were rated by children and parents using the Health and Behavior Inventory. Linear mixed-effects models assessed the associations of SDoH (i.e., race, household income, parental education, insurance status, neighborhood deprivation) and their interactions with time with post-concussion symptom severity. The cumulative impact of all SDoH was assessed with negative binomial generalized linear models at 3 months post-injury. In the linear mixed-effects models, race and education were significant predictors of both child-reported, race: F(5, 1390.37) = 2.27, p = 0.05; education: F(3, 1155.55) = 3.14, p = 0.03, and parent-reported somatic symptoms, race: F(5, 2562.35) = 2.93, p = 0.01; education: F(3, 787.22) = 3.28, p = 0.02. Joint tests of race, F(15, 804.38) = 2.12, p = 0.008, and neighborhood deprivation, F(3, 379.12) = 2.74, p = 0.04, and their interactions with time variables were statistically significant for parent-reported somatic symptoms. In the negative binomial generalized linear models, SDoH cumulatively contributed to the prediction of symptoms at 3 months post-injury over and above injury type (concussion vs. OI) and known prognostic factors (5P risk score) for child-reported cognitive, F(17, 1154.75) = 1.94, p = 0.012, and somatic, F(17, 322.81 = 2.11, p = 0.007, symptoms and parent-reported somatic symptoms, F(17, 327.15) = 1.93, p = 0.015. In summary, individual SDoH had small associations with symptoms after concussion in Canadian children, but the cumulative effects of multiple SDoH are likely an important factor in post-concussion symptom severity.
Very low uptake in workplace semen analysis research is difficult to interpret, particularly in employer-adjacent settings, where nonparticipation may reflect limited recruitment reach, limited understanding of the occupational rationale, low perceived relevance, or procedure-related concerns. This post hoc formative study described self-reported awareness of a parent workplace semen analysis study as an indicator of effective recruitment reach, reported reasons for nonparticipation under the implemented survey condition, and design issues for exposure-defined workplace reproductive health research. In April-May 2025, we conducted an anonymous web-based cross-sectional follow-up survey among male employees in Japan who had been eligible for, but had not completed, a parent workplace semen analysis study. The parent study invited approximately 2000 male employees from 3 companies between November 2024 and January 2025; 6 completed the protocol. The follow-up survey invited approximately 900 male employees from 1 company. Part 1 assessed awareness, reasons for nonparticipation, interest in male reproductive health information, and general openness to future related research. Optional Part 2 assessed age, knowledge, concerns, expected reactions, and willingness under simplified conditions. Responses were summarized descriptively using Wilson 95% CIs; no hypothesis testing was performed. We analyzed 108 submitted questionnaires; 83 respondents completed Part 2. Overall, 74/108 (68.5%; 95% CI 59.3-76.5) respondents reported no awareness of the parent study. Among unaware respondents, 68/74 (91.9%; 95% CI 83.4-96.2) selected "did not know the study existed." Among aware nonparticipants, the most frequent reasons were perceived irrelevance and resistance to collecting semen (each 9/34, 26.5%; 95% CI 14.6-43.1), embarrassment or reluctance (8/34, 23.5%; 95% CI 12.4-40), and hassle (7/34, 20.6%; 95% CI 10.3-36.8). In Part 2, anxiety about unfavorable results was reported by 52/83 (62.7%; 95% CI 51.9-72.3) respondents, concerns about collection location or privacy protection by 48/83 (57.8%; 95% CI 47.1-67.9), and self-reported resistance by 42/83 (50.6%; 95% CI 40.1-61.1). Under simplified conditions, 36/83 (43.4%; 95% CI 33.2-54.1) respondents indicated willingness to undergo semen analysis. Very low uptake in this employer-adjacent semen analysis study was not interpretable as a single phenomenon. This post hoc formative process evaluation identified limited awareness, suggesting limited effective recruitment reach under the implemented procedures, and characterized the reason profile among aware nonparticipants, including low perceived relevance and semen collection-related concerns. Rather than identifying primary causal determinants of nonparticipation, the findings support a bounded recruitment-methodological interpretation and highlight recruitment-cascade components for prospective measurement: objective exposure to recruitment materials, information access, understanding of the occupational rationale, voluntary postinformation declination, privacy concerns, logistical burden, and specimen-return completion. Informed acceptability after occupational reproductive-hazard education should be evaluated in future designs that include such education and comprehension assessment.
A brain tumor can lead to functional impairment, which is particularly concerning for adolescents and young adults (AYA). Patient-reported outcomes (PROs) have typically been examined as isolated domains, rather than as covarying symptoms. This study modeled PRO networks, symptom clustering, and topology among AYA oncology survivors. Patient-reported outcome networks from 4005 survivors were compared in topology between survivors of primary CNS tumors (n = 164) and non-CNS tumors (n = 3841). Survivors were diagnosed between 1999 and 2015 at ages 18 to 39 years, who completed the EORTC QLQ-SURV100 (Mdn follow-up = 12.31 years). Group-specific networks were estimated based on 33 health-related quality of life (HRQoL) scale scores using graphical LASSO. Wilcoxon rank-sum tests and the Network Comparison Test assessed group differences in the original PRO scales and their network centrality, respectively. Within the CNS subgroup (n = 164), associations with tumor-related and treatment-related characteristics were explored. Survivors of central nervous system (CNS) tumors reported higher symptom burden on most PRO scales, along with a more diffuse network showing weaker within-domain cohesion (lower nodal strength and expected influence) and limited cross-domain integration (lower bridge strength). A small subset of nodes showed higher bridge expected influence (ie, fatigue, physical functioning, sexual problems when sexually active, work), which may represent key targets for intervention. Across both groups, negative health outlook, health distress, and physical functioning emerged as consistent core targets. Core symptoms may warrant prioritization in clinical follow-up and treatment of cancer survivors. These findings contribute to further development and optimization of tailored neurorehabilitation programs in neuro-oncological care.
Problem-solving is essential for the self-management of type 2 diabetes but remains challenging for underserved individuals. Although mobile health (mHealth) interventions can improve diabetes self-management, few focus on problem-solving. This study evaluates the efficacy of Mobile Diabetes Detective (MoDD), a fully automated web-based intervention with SMS text messaging that provides problem-solving support tailored to self-monitoring data, for improving glycemic control among medically underserved adults with type 2 diabetes. This open-label, 1:1 cluster-randomized controlled trial was conducted in 2013-2018. Participants were adults with type 2 diabetes (glycated hemoglobin [HbA1c] >7.5%) receiving care at 8 Federally Qualified Health Centers serving medically underserved communities in the New York metropolitan area. The centers served as clusters and were randomized using computer-generated allocation. Recruitment and study sessions were conducted either in person or in a hybrid format. The intervention arm used MoDD for 12 months, whereas the control arm received standard diabetes education and routine care. The primary outcome was the change in HbA1c from baseline to 12 months, recorded from medical chart data. We hypothesized greater improvement in the intervention arm than in the control arm. Secondary outcomes included psychosocial measures. Outcomes were compared between groups using intention-to-treat analyses. This report presents the final analysis of the outcomes. This trial randomized 248 participants (intervention arm: n=126; control arm: n=122); 219 were included in the final analysis (intervention arm: n=111; control arm: n=108). Participants were predominantly female (147/219, 67.1%) and ethnically and racially diverse (112/219, 51.1%, Hispanic and 92/219, 42%, African American), with a mean baseline HbA1c of 9.9%. Overall, of the 111 participants, 44 (39.6%) engaged with MoDD at least once weekly in the first 30 days, and 22 (19.8%) engaged at least once weekly in the first 90 days. HbA1c did not differ significantly between groups at baseline (intervention: 9.81%, 95% CI 9.42%-10.20%; control: 9.95%, 95% CI 9.55%-10.34%; difference=0.14%, P=.63) or at 12 months (intervention: 9.36%, 95% CI 8.95%-9.78%; control: 9.58%, 95% CI 9.15%-10.01%; difference=-0.22%, P=.47). Both groups demonstrated reductions in HbA1c from baseline to 3 months. Sustained within-group improvement at 12 months was observed in the intervention group but not in the control group. No intervention-related adverse events were reported. This study evaluated the impact of a mobile intervention for problem-solving in diabetes. MoDD is innovative because it operates autonomously and tailors support to individuals' self-monitoring data. Although there was no significant between-group difference in HbA1c, the intervention group showed sustained within-group improvement at 12 months. These findings highlight the potential long-term benefits of autonomous mHealth interventions for problem-solving. The study observed an increase in diabetes distress, possibly reflecting heightened awareness of uncontrolled blood glucose levels. If implemented in clinical practice, MoDD could complement diabetes education and help improve glycemic control. ClinicalTrials.gov NCT02021591; https://clinicaltrials.gov/ct2/show/NCT02021591.
The intersection between Autism Spectrum Disorder (ASD) and gender diversity (GD), particularly among transgender and non-binary individuals, has gained increasing attention in recent literature. This population experiences dual vulnerability related to structural stigma, pathologization, and barriers to accessing healthcare. The 2024 Cass Review (UK) has significantly influenced clinical debate, challenging affirmative care models and generating ethical and political tensions. To explore scientific evidence published between January 2024 and April 2025 regarding the experiences, trajectories, barriers, and needs of transgender and non-binary individuals with a clinical or self-identified ASD diagnosis. A scoping review was conducted following the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR guidelines. Searches were performed in Scopus, Web of Science, and SciELO between April 1 and April 21, 2025. Empirical studies-qualitative, quantitative, or mixed-methods-published in English or Spanish were included. A total of 34 articles met eligibility criteria. Seven thematic axes were identified: mental health, ASD-GD co-occurrence, access barriers, affirmative care, structural discrimination, limited family support, and community participation. Studies reported substantial mental health burden, lack of sensory accommodations, institutional exclusion, and family rejection. Approximately 40% proposed trans-affirmative or neurodivergence-affirmative models. Most studies originated from the Global North. The findings underscore the urgent need for culturally competent, intersectional, and rights-based models of care. In the post-Cass context, adopting an affirmative approach represents not only an ethical stance but a public health imperative to uphold the right to health for autistic transgender individuals.
To explore agreement between self-report and objectively measured adherence to brace wearing by patients with knee osteoarthritis. A single-arm observational analysis nested within the PROP OA randomised controlled trial (ISRCTN28555470). Of 237 adults with symptomatic knee osteoarthritis randomised to brace treatment, 60 were included in this sub-study investigating three different methods of assessing knee brace wear time over 26 weeks: 1. Self-report questionnaires (SRQ) at 12 weeks and 26 weeks; 2. Short message service (SMS) questions (days worn in past week, typical hours per day when worn) administered from week 1 to week 24; 3. A skin temperature sensor embedded in the brace, sampling every 10 minutes for 26 weeks. The presence and reason for the sensor were concealed from participants. The estimated proportion of participants meeting "minimum brace use", defined a priori as ≥1 hour on ≥2 days in past week, was described for each measurement method, overall and by brace type (unloader, neutral). For temperature sensor measurements, time spent above 24oC and time spent above 25oC were used. Agreement between the measures was summarised by percentage agreement and kappa (ĸ). The estimated proportions of participants meeting "minimum brace use" at 12 weeks were 83% (SRQ), 83% (SMS), 60% and 58% (temperature sensor, 24oC and 25oC thresholds, respectively). At 26 weeks, the corresponding estimates reduced to 72%, 71% (SMS at 24 weeks), 43% and 37%. Sensor data suggested the sharpest decline in brace use occurred within the first 12 weeks. Agreement between self-report measures was higher than between self-report measures and sensor (SRQ vs SMS at 12 weeks: 92% agreement, ĸ=0.67 (95%CI: 0.34, 1.00); SRQ vs Sensor at 12 weeks: 74%, 0.35 (0.10, 0.60); SMS vs Sens at 12 weeks: 76%, 0.36 (0.05, 0.66). Agreement between all measurement methods reduced at 26 weeks. This novel use of a temperature sensor to monitor brace adherence in knee osteoarthritis indicates that self-report adherence substantially overestimates knee brace wearing time, with implications for clinical trials and practice.
Leadership research increasingly emphasizes the role of health-oriented leadership (HoL) for employee well-being and motivation, yet the motivational relevance of leaders' own self-care remains insufficiently understood. Addressing this gap, the present study integrates the HoL framework with self-determination theory (SDT) to examine how leader self-care relates to employees' basic psychological need satisfaction and intrinsic motivation. Building on SDT, self-care is conceptualized as a form of health-related self-regulation that supports the satisfaction of the basic psychological needs for autonomy, competence, and relatedness. The study proposes a theoretically ordered model in which leader self-care is associated with staff-care, employee self-care, need satisfaction, and intrinsic motivation, thereby extending prior research that has primarily focused on leaders' health-supportive behavior toward employees. Data were collected from 122 employees in Germany using a cross-sectional online survey. Regression analyses showed that leader self-care was a strong and significant predictor of staff-care (b = 1.01, p < 0.001) and employee self-care (b = 0.37, p < 0.001). Within the mediation model, staff-care was positively but not significantly associated with basic psychological need satisfaction (b = 0.12, p = 0.055), and the indirect effect of leader self-care on need satisfaction via staff-care was not statistically significant (b = 0.12, 95% CI [0.00, 0.25]). In contrast, employee self-care was a significant predictor of need satisfaction (b = 0.41, p < 0.001), which in turn strongly predicted intrinsic motivation (b = 1.06, p < 0.001). These findings suggest that HoL may influence motivation less through direct supportive behavior and more through enabling employees' self-regulatory engagement. By identifying employee self-care as a proximal correlate of need satisfaction, the study contributes to a more differentiated understanding of how leadership-related health resources translate into motivational outcomes. The study is limited by its cross-sectional design, reliance on self-report data, and geographically restricted sample. Future research should employ longitudinal and multi-source designs to examine causal mechanisms and contextual boundary conditions.
Alexithymia has been proposed as a potential risk/vulnerability factor for affective disorder symptoms, but the processes accounting for this association require further specification. Preece et al. (2022) reported that emotion regulation difficulties statistically mediated the alexithymia-affective symptom association in a U.S. community sample (N = 501). Independent replication across alternative measures and in clinical and clinically enriched community samples is needed. In a community sample of 661 U.S. adults (28.6% reporting at least one lifetime psychiatric diagnosis; 41% reporting a history of mental health treatment), we conducted a conceptual and extended replication of the Preece et al. (2022) model with the Perth Alexithymia Questionnaire (PAQ), Perth Emotion Regulation Competency Inventory (PERCI), and Depression Anxiety Stress Scales-21 (DASS-21), and tested three additional models substituting the 20-item Toronto Alexithymia Scale (TAS-20) for the PAQ and the Difficulties in Emotion Regulation Scale (DERS) for the PERCI in a fully crossed design. Sensitivity analyses re-estimated the DERS-based models with a "purified" DERS excluding the Awareness and Clarity subscales. Standardized indirect effects were similar for both PERCI-based models (β = 0.32-0.34) and notably larger for both full-DERS models (β = 0.50-0.51). When the DERS Awareness and Clarity subscales were excluded, the standardized indirect effects in the purified-DERS models fell to β = 0.33-0.34, converging with the PERCI-based estimates. The pattern was preserved with depression, anxiety, and stress subscales examined separately, and within the lifetime-diagnosis subsample. The data are cross-sectional and rely on self-report, with associated risk of common-method variance. When shared item content between alexithymia and emotion regulation measures is minimized, the standardized indirect effect of alexithymia on affective symptoms through emotion regulation difficulties converges around β ≈ 0.33 across the two alexithymia operationalizations and both emotion regulation instruments. This pattern is consistent with, but does not establish, the hypothesized ordering in which alexithymia relates to affective symptoms through emotion regulation difficulties, and the robustness across operationalizations should not be interpreted as adjudicating between the original, affect-deficit and attention-appraisal models of alexithymia.
One in four older adults report experiencing current anxiety or depression, yet fewer than 20% access formal mental health care services. To better understand this treatment gap, the present study investigated the influence of sociocultural factors (e.g., close others stigma, self-stigma, internalized ageism, emotional control, self-reliance, provider cultural humility, logistical barriers, psychological distress, social support) on professional mental health help-seeking intention among older adults (age ≥ 55) in the United States, using the Integrated Behavioral Model of Mental Health Help-Seeking. Structural equation modeling was used to determine which of these sociocultural factors demonstrated an independent indirect effect on intention, as well as the Integrated Behavioral Model of Mental Health Help-Seeking mechanisms (attitude, perceived norm, personal agency) that mediate these indirect effects. Self-stigma of seeking help, perceived provider cultural humility, and psychological distress demonstrated the clearest connection with intention via the mediators of attitude and/or perceived norm. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
To evaluate the impact of cancer treatment on the health-related quality of life (HRQoL) of children and adolescents. HRQoL self-perception was assessed using the Pediatric Quality of Life Inventory 3.0 Cancer Module (PedsQL), applied to 103 children and adolescents aged 1 to 18 years, recruited from a hematology and oncology unit of a Brazil public hospital and a support house. Sociodemographic and health data were collected through structured questionnaires, and a dental examination was conducted to assess dental caries. Data were analyzed using SPSS, including descriptive and Chi-square tests. Most participants were male (54.4%), aged 1-7 years (55.3%), with a primary diagnosis of hematologic and lymphatic cancer (85.4%). Family income was up to one minimum wage (55.3%), and 70.9% of mothers had at least 8 years of education. Children aged 1-7 scored lower in "Procedural Anxiety" (45.14 ± 40.37) than adolescents (66.67 ± 36.30). Adolescents scored lower in "Nausea" (55.11 ± 30.06) and "Worry" (56.34 ± 38.69) than children. HRQoL scores were associated with age (p < 0.001), maternal education (p = 0.022), brushing frequency (p = 0.046), and decayed teeth (p = 0.001). In the final model, self-reported HRQoL among children and adolescents aged 8 to 18 years (OR = 4.28; 95% CI: 1.07-17.12) was associated with lower HRQoL. Anxiety, nausea, and worry negatively impact the health-related HRQoL of pediatric cancer patients, and sociodemographic factors, such as the child's age, also influence this perception, highlighting the importance of individualized and integrated approaches to care.
The mechanisms underpinning associations between sleep and psychiatric conditions are poorly understood, partly due to challenges with longitudinal sleep studies outside the laboratory. Children and young people with rare genetic conditions caused by micro-deletions or -duplications (Copy Number Variants or CNVs) have increased risk of disrupted sleep and poorer neurodevelopmental (ND) outcomes. The 'Sleep Detectives' study aims to investigate this by tracking behavioural and neurophysiological signatures of sleep health in young people with ND risk or ND-CNVs. To optimally achieve this, we worked with families with ND-CNVs and charity partners to co-design our tools, methods, study protocol, and materials. We established a Lived Experience Advisory Group (LEAP): nine parents, 13 children and young people with ND-CNVs, and representatives of UK charities Max Appeal and Unique. Together, the research team and LEAP co-designed two in-person family workshops to collect feedback on acceptability of sleep monitoring devices, the design of bespoke cognitive tasks, and overall study protocol. Informal interviews and surveys enabled LEAP members and researchers to reflect and learn from their Patient/Public Involvement (PPI) experiences. Key outputs included pre-workshop information materials, and multiple insights and recommendations, all of which were incorporated iteratively in refining 16 different aspects of the main study design. These included more flexibility in data collection, selection of sleep devices, customisation of cognitive tasks, and improved document language. In a survey, 100% of workshop respondents (15/15) were positive or very positive about the overall study. The PPI process was highly valued by LEAP members, workshop attendees, and the research team. One investigator described it as "reinvigorating my love of research by helping me focus on science that matters". Participating families also established peer support networks. Involving families affected by ND-CNVs in study co-design maximised opportunities for acceptability, accessibility and scalability. The researchers gained inspiration and deeper understanding of the impact of ND-CNVs on families. Families gained awareness about research, established connections with each other and peer support, and were enthusiastic about future research involvement. This experience empowered families to engage more deeply with the research process and made the PPI work more impactful and inclusive. Children and young people with rare genetic conditions caused by small deletion or duplication of genetic material are more likely to experience sleep difficulties such as insomnia, restless sleep, and tiredness. They also show an increased likelihood of neurodevelopmental conditions such as learning disability and autism, and mental health issues such as anxiety. The Sleep Detectives team wanted to explore how these genetic conditions affect children’s sleep, cognition and psychiatric health. To make sure that the project design was well suited to the children and young people that would be invited to participate, the team worked closely with families to design the study. Parents and caregivers of affected children and young people were invited to join a Lived Experience Advisory Panel (LEAP), together with charity representatives and Sleep Detectives researchers, to co-design two hands-on workshops, and advise on study design. Children and young people and parents/caregivers attending the workshops tried out and provided feedback on tools and devices that the research team were developing. They also advised on the arrangements and support families might need whilst taking part, and on the study protocol. This collaborative approach helped ensure the study design was optimally suited for the recruitment and participation of children and young people and their families. This report documents our public involvement work for the Sleep Detectives study, illustrating the difference the partnership between researchers and families has made to the project, and the wider benefits for all concerned.
University students regularly report insufficient sleep, with almost one-third of students achieving less than 6.5 hours per night. Social media is one behaviour shown to negatively influence sleep. However, there has been a reliance on self-report measures of both processes, which may not reflect objective behaviour. The aim was to determine if there is a relationship between social media use and sleep outcomes when measured objectively, and if so, which sleep outcomes were associated with social media use. A longitudinal repeated measures design was used to assess daily social media use and sleep outcomes over 14 days. Participants wore accelerometers to measure their sleep, with total daily social media use derived from smartphone data. Sixty-two participants (Mage = 22.11 years, SD = 5.82 years) completed the study. Linear mixed models revealed no between or within-participant effects of daily social media on sleep duration, sleep onset latency, sleep efficiency and bedtime. However, TikTok showed a positive between-participants effect on bedtime. A generalized linear mixed model also revealed that Snapchat had a negative between-participants effect on sleep onset latency. Findings indicate that the duration of time spent on social media does not impact sleep across this sample. However, interactions with different social media platforms such as TikTok and Snapchat may play an important role in influencing sleep quality. These findings suggest that behavioural measures do not reflect the same pattern of effects observed with self-report, highlighting the need for future research to corroborate findings derived from self-report.
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.
Advances in neonatal care have improved survival rates of preterm and growth-restricted infants. However, concerns remain regarding their long-term psychosocial development. This study investigated psychosocial outcomes in adults born preterm or growth-restricted. The Gutenberg Prematurity Study is a retrospective cohort study including 606 participants (326 women, 53.8%) aged 18-52 years. Participants were categorized by gestational age (GA) as extremely preterm (≤28 weeks), very preterm (29-32 weeks), moderately preterm (33-36 weeks), and term (≥37 weeks), and by birth weight percentile as small for GA (SGA), appropriate for GA, and large for GA. Logistic regression assessed associations of GA and birth weight with romantic relationships and health-risk behaviours. Socio-economic status (SES) parameters were analysed using linear regression. Extremely and very preterm participants reported fewer health-risk behaviours, particularly lower alcohol consumption [extremely preterm: odds ratio (OR) = 0.26; 95% confidence interval (CI): 0.13-0.49; P < 0.001]. Similarly, participants born SGA were less likely to report current alcohol consumption (OR = 0.63; 95% CI: 0.41-0.98; P = 0.04). A trend towards lower odds of ever having been in a romantic relationship was observed (OR = 0.35; 95% CI: 0.11-1.09; P = 0.07). Being born extremely or moderately preterm was associated with lower overall SES (extremely preterm: β = -2.25; 95% CI: -3.22 to -1.27; P < 0.001; moderately preterm: β = -1.04; 95% CI: -1.73 to -0.35; P = 0.003). No significant associations were found for present relationship status, relationship satisfaction, or smoking behaviour. Preterm birth and foetal growth restriction are associated with adult psychosocial outcomes, with preterm birth more strongly affecting socio-economic outcomes, underscoring the need for targeted support.
Persistent physical symptoms (PPS) can significantly impair health-related quality of life (HRQoL). Psychological flexibility (PF), characterized by the ability to adapt functionally and congruently to diverse situations based on personal values, may moderate the impairment of HRQoL. This study examined whether the intervention based on internet-delivered acceptance and commitment therapy (iACT) combined with individual case formulation and treatment as usual (TAU) (n = 50) was effective in improving HRQoL compared to TAU alone (n = 53) in adults with PPS associated with indoor environment and/or chronic fatigue syndrome. Then, the mediating role of PF was explored. In this trial (ClinicalTrials.gov NCT04532827), self-report questionnaires were administered to evaluate HRQoL, and PF, including general PF, cognitive fusion, and thought suppression. The primary outcome was HRQoL. Outcomes were assessed at baseline, at post-intervention (3 months from baseline), and at 3- and 9-month follow-ups from post-intervention. Significant interaction effects for HRQoL were found in the iACT + TAU group from baseline to the 9-month follow-up (p = 0.003), indicating the HRQoL increased more in the iACT + TAU group, compared to the TAU alone (p = 0.164). PF did not mediate the change of HRQoL during the follow-up. The iACT + TAU combined with individual case formulation significantly increased HRQoL compared to TAU alone. However, no mediation effects were observed, suggesting that PF did not mediate the change in HRQoL. Further research on mechanisms of change is warranted to enhance understanding of both conditions and lead to more effective treatments.