Sleep disorders are a prevalent concern among older adults, contributing to reduced physical function. A bidirectional relationship between sleep disorders and frailty syndrome has been suggested. This study aimed to investigate sleep quality and its associations with physical activity and frailty syndrome among hospitalized older adults. A cross-sectional study was conducted in 2022 among 150 hospitalized older adults in East Guilan, northern Iran, using convenience sampling. PSQI, CHAMPS, and TFI questionnaires were employed as research instruments. Data were analyzed using SPSS version 16, applying descriptive statistics and Spearman correlation coefficients. The majority (76%) of participants had poor sleep quality, and 58.66% reported being physically active. Additionally, 58% were non-frail. Although no significant relationship was found between the total sleep quality score and frailty syndrome, a significant correlation was observed between habitual sleep efficiency and all dimensions of frailty (physical, psychological, and social). A positive relationship was also found between sleep quality and physical activity (r = 0.20, p = 0.014). Improved physical activity was associated with better sleep quality, which may reduce risk of frailty. Promoting physical activity and improving sleep hygiene in hospitalized older adults could enhance health outcomes and reduce frailty risk.
The COVID-19 pandemic and associated school closures presented unprecedented challenges to university students' well-being, highlighting an urgent need to understand the factors influencing their health-related quality of life. This study aimed to explore the association between psychological distress, lifestyle, and career planning on the health-related quality of life of university students during the school closure period in China. A cross-sectional study was conducted, collecting data from 1965 Chinese college students locked down in campus during COVID-19 using a snowball sampling method via an online questionnaire platform (Wenjuan.com). Psychological distress and the health-related quality of life were measured by scales. Descriptive analysis, Chi-squared test and logistic regression analysis were employed to analyze the data. The mean physical component summary score was 47.5, while the mean mental component summary score was 36.8. Students who were women (OR=1.444, P = 0.003), having a boy or girl friend (OR=1.379, P = 0.008), with rural hukou (OR=1.446, P = 0.004), with low psychological distress (OR=4.589, P < 0.001), high physical activity intensity (OR=3.909, P < 0.001), a regular studying schedule arrangement (OR=2.553, P = 0.008), clear career planning (OR=1.570, P = 0.001) during COVID-19 were more likely to report a good physical component summary. For mental component summary, lower psychological distress (OR=8.330, P < 0.001), a regular studying schedule arrangement (OR=2.892, P = 0.001) and keeping same job-hunting pressure (OR=1.852, P = 0.003) were positive influencing factors, whereas having a boy or girl friend (OR=0.774, P = 0.032) and having no clear career planning (OR=0.752, P = 0.020) during COVID-19 were negative influencing factors. In conclusion, while health-related quality of life was generally good, lower psychological distress, healthier lifestyle habits, and clearer career planning were significantly associated with better health-related quality of life among university students during the pandemic-related school closure. These findings underscore the importance of integrating mental health support, lifestyle guidance, and career planning services into student support systems during public health crises. Future studies should develop and evaluate interventions targeting these modifiable factors.
A 27-year-old primigravida at 9 weeks' gestation underwent emergency laparoscopic ovarian surgery under combined spinal-epidural anesthesia. During pneumoperitoneum, bilateral shoulder-tip pain developed after Trendelenburg positioning. Intravenous acetaminophen (1000 mg) was initiated, and pain improved within 10 minutes, allowing surgery to continue without lowering insufflation pressure, administering additional opioids or sedatives, or converting to general anesthesia. Pain resolved after desufflation. Maternal oxygenation remained stable, and fetal cardiac activity was reassuring before and after surgery. This case suggests that intravenous acetaminophen may be an opioid-sparing rescue option for intraoperative shoulder-tip pain during awake laparoscopy in early pregnancy.
This study examined the category specificity of a previously reported reciprocal interference between holistic face and word processing by incorporating body stimuli as a control. Prior work has demonstrated that superimposed faces and words disrupt each other's holistic processing: faces are processed less holistically when paired with aligned words, and vice versa. Here, we asked whether a similar pattern of interference extends to body stimuli. In Experiment 1, we assessed whether face alignment would influence holistic body processing. We found no difference in holistic body processing between face-aligned and face-misaligned conditions, suggesting that faces do not interfere with holistic body processing. In Experiment 2, we examined whether word alignment affected body processing and again found no evidence of interference. Together, these findings indicate that body processing is unaffected by the alignment of overlaid words or faces, highlighting both the specificity and the limits of shared holistic processing mechanisms across high-level visual categories.
Breast cancer patients often experience significant psychological distress. This study examined distress trajectories from diagnosis to 6 months post-treatment and explored differences across demographic, medical, and psychosocial subgroups. In this prospective cohort study, 528 patients with breast cancer were recruited between 1 December 2023 and 31 December 2024. Assessments were conducted at baseline (at diagnosis, T0), after the first treatment (T1), mid-treatment (T2), at treatment completion (T3), and at three (T4) and six months (T5) post-treatment. Growth mixture modeling (GMM) was used to identify distinct trajectories of psychological distress. Multinomial logistic regression analysis was performed to examine associations between patient-related factors and trajectory membership. Three psychological distress trajectories were identified: a high-distress remission group (17.05%), a moderate-stable distress group (11.93%), and a low-fluctuating distress group (71.02%). Multivariable analyses showed that higher educational attainment, breast-conserving surgery, early disease stage, partial self-management ability, and strong social support were associated with membership in the moderate-stable or low-fluctuating groups (p < 0.05). Employment, health insurance coverage, avoidant medical coping style, and higher baseline anxiety and depression scores were concurrently associated with membership in the high-distress remission group (p < 0.05). Although psychological distress generally decreased over time, 71.02% of patients followed a low-fluctuating trajectory, 11.93% maintained moderate distress with potential risk of persistence, and 17.05% showed high initial distress that remitted substantially within 6 months. Continuous monitoring and early psychosocial support are recommended, particularly for patients with moderate- or high-risk trajectories.
Hospital environments are often characterized by high stress and demanding workloads, which can negatively impact staff well-being and the quality of patient care. Code Lavender (CL) is an emotional crisis intervention designed to support health care staff during or after stressful incidents. King Faisal Specialist Hospital and Research Center in Jeddah (KFSHRC-J) has developed and implemented a robust CL program that has demonstrated professional, organizational, and personal benefits.
Disordered eating (DE) significantly affects both physical and mental health, contributing to morbidity, mortality, and considerable global healthcare costs. This cross-sectional study assessed the prevalence of high-risk DE and examined its associations with body composition, behavioural factors, diet quality, and perceived stress among university students in the United Arab Emirates. A total of 911 students were recruited using non-probability quota sampling (50.49% female). Body composition was measured using a TANITA BC-420MA body composition monitor. Usual dietary intake was assessed via a validated 65-item food frequency questionnaire. DE risk was assessed using the Eating Attitudes Test (EAT-26) and perceived stress using the PSS-10. Analysis included linear regression and independent-samples t-test (p < 0.05). High-risk DE (EAT-26 ≥ 20) prevalence was 30.3%. High-risk DE was significantly associated with higher body fat percentage (β = 0.121, p < 0.001), fat mass (β = 0.148, p < 0.001), fat-free mass (β = 0.079, p = 0.017), lean mass (β = 0.08, p = 0.016), total body water (β = 0.084, p = 0.011), and lower total body water percentage (β = -0.131, p < 0.001). High-risk students also reported higher intakes of fibre (β = 0.12, p = 0.018), beta-carotene (β = 0.14, p = 0.025), vitamin A (β = 0.13, p = 0.034), B12 (β = 0.15, p = 0.043), folate (β = 0.16, p = 0.006), and vitamin D (β = 0.16, p = 0.036). Compared with the low-risk group, high-risk DE was associated with higher adiposity markers and slightly higher perceived stress, and differed in selected nutrient intakes; sociodemographic characteristics were largely similar between groups except for smoking status. These findings support the implementation of targeted prevention strategies, including nutrition education, routine screening, and culturally tailored programmes, for young adults in the UAE.
Chronic pain of peripheral nerve origin is a prevalent condition that often remains resistant to conservative therapies. Peripheral nerve stimulation (PNS) has proven to be an effective intervention for managing this type of pain. Receiver based PNS is a neuromodulation therapy designed to alleviate chronic pain by targeting specific peripheral nerves. This system involves implanting an electrode array and separate receiver to target pain-causing nerves, offering relief for patients with persistent pain. A case series involving 9 patients with chronic peripheral nerve pain treated with a peripheral nerve stimulation system with a separate receiver is presented. These patients had pain localized to specific nerve targets, including the suprascapular, infrapatellar saphenous, and superior cluneal nerves. After successful trials, the Freedom® PNS System (Curonix LLC) was implanted permanently. Pain relief was assessed using the Verbal Rating Scale (VRS), showing significant improvement in pain scores from baseline to follow-up periods of one, 3, and 6 months. PNS is a safe, effective method for treating chronic pain that originates in the peripheral nerves and is resistant to conservative therapy.
Central neuropathic pain that follows spinal cord injury is often refractory to medical therapy. Spinal cord stimulation (SCS) is an established treatment for chronic neuropathic pain, but conventional dorsal column placement may not capture all pain regions. A 63-year-old man with C6-T2 spinal cord infarction and C7 ASIA C paraplegia experienced severe refractory pain in both feet and the left leg for over a decade. Two dorsal leads provided coverage for the feet but not the leg. An additional ventral lead at T12 captured the buttock and hamstring, reducing pain from 9/10 to 3/10. Permanent implantation yielded >80% relief at 2 years. This case demonstrated durable relief with ventral SCS lead placement when dorsal stimulation alone was inadequate, underscoring the value of individualized strategies for central neuropathic pain as well as the potential for the role of ventral lead placement.
Cortico-thalamo-cortical oscillations are central to both normal and pathological brain activities and emerge from complex cortical and thalamic interactions. However, the specific activity of identified cortical neurons during the paroxysmal oscillations associated with absence seizures (ASs) in awake animals remains underexplored. The dominant narrative suggests that seizures indiscriminately disrupt cortical activity through uniform increases in neuronal excitability; however, direct evidence for such homogeneous recruitment at the single-neuron level is lacking. Here, we recorded single units from pyramidal neurons and different interneuron subtypes in the neocortex of two validated rodent models of absence epilepsy under awake, behaving conditions. We find that neurons maintain their firing rank order across interictal and ictal states, regardless of whether their ictal firing rate increases, decreases, or remains stable compared to the interictal phase. Rather than a random cortical takeover, ictal activity represents a scalable modulation of pre-existing network states. These results challenge the generalized hyperexcitability model and highlight the structured, heterogeneous nature of cortical activity during ASs, with implications for mechanistic understanding and targeted therapies.
High-impact chronic pain (HICP) involves substantial interference in functioning, affects 8.5% of the population, and leads to higher health care costs relative to low-impact chronic pain (LICP). Behavioral interventions such as virtual reality (VR) offer scalable and accessible treatment, but testing is needed to ensure durable effectiveness in HICP. We conducted a secondary analysis of the largest real-world dataset for a therapeutic skill-based VR vs a sham VR control to test treatment efficacy in HICP vs LICP. Relative to LICP, we found significantly larger (and clinically meaningful; ie, ≥2 points) pain interference and pain intensity reductions for HICP at end of treatment and 1 year posttreatment. End-of-treatment reduction in pain interference reclassified 70% (114/163) of participants with HICP as LICP, and this improvement held at 1 year posttreatment (104/155, 67%). This study examined the effectiveness of a 56-session skill-based VR therapy in HICP at 2 years posttreatment and compared the effects with those on LICP. We conducted a secondary analysis of the skill-based VR sample (536/1067, 50.2%) at 2 years posttreatment from a randomized controlled trial involving an in-home chronic low back pain sample that was recruited and tested online and was diverse (female: 411/536, 77%; non-White individuals: 166/536, 31%; high school or lower educational level: 102/536, 19%; mean age 50.8 years) and had clinically severe pain at baseline (intensity=6.6; interference=6.2; 42% with severe or complete disability). Focusing on the skill-based VR participants (536/1067, 50.2%) and using a validated approach, we classified participants at baseline as either HICP (baseline Brief Pain Inventory pain interference score>7) or LICP (baseline Brief Pain Inventory pain interference score<7). Clinical effectiveness was examined using a general linear model at 2 years posttreatment relative to baseline with the primary outcomes of pain interference and pain intensity. Participants with HICP (192/536, 35.8%) reported superior reductions in pain interference, pain intensity, sleep disturbance, and physical disability (P<.001 in all cases) at 2 years posttreatment compared to participants with LICP (344/536, 64.2%). Participants with HICP had clinically meaningful (≥2-point) reductions in pain interference (mean 3.1, 95% CI 2.66-3.54; effect size=1.12) and pain intensity (mean 2.6, 95% CI 2.18-3.02; effect size=1.01) at 2 years posttreatment. Importantly, reduced pain interference scores at 2 years posttreatment reclassified 71.1% (106/149) of the participants with HICP as LICP. No serious adverse events or side effects were reported. Patients with HICP experience severe pain that drives high health care use. The skill-based VR therapy demonstrated durable reductions in pain and related outcomes 2 years posttreatment, with the largest benefits observed in the HICP subgroup. These results suggest that a skill-based, VR-delivered therapy produces durable effects in patients with HICP, a population that is frequently overmedicalized and undertreated with behavioral interventions. These findings suggest that home-based VR-delivered therapy offers a scalable treatment option for this underserved population.
Chronic hip and pelvic pain following trauma can be challenging to treat, particularly when pain originates from multiple nerve distributions. Traditional treatments often provide limited relief; peripheral nerve stimulation is a minimally invasive alternative. A 68-year-old woman with persistent pelvic and hip pain following a right iliac wing fracture reported minimal response to medications and injections. Diagnostic nerve blocks targeting the obturator nerve, femoral sensory branches, and middle cluneal nerve, provided significant but short-term pain relief. A peripheral nerve stimulation trial targeting the middle cluneal, obturator, and femoral nerves resulted in a 75% reduction in pain. Following permanent implantation, a revision was required due to lead migration. Post revision, pain levels stabilized at 3-4/10 across both anterior and posterior pain distributions, with sustained improvement at 12 months. This case demonstrates the feasibility and sustained benefit of externally powered peripheral nerve stimulation for chronic posttraumatic hip and pelvic pain.
Emerging evidence suggests vitamin D deficiency might be linked to increased headache risk, though consistent conclusions are lacking due to population and methodological heterogeneity. In addition, childhood and adolescent obesity may influence headache development through metabolic and inflammatory pathways, but the specific role of body mass index (BMI) in the relationship between vitamin D and headache is currently unclear. Therefore, this study used National Health and Nutrition Examination Survey (NHANES) large-scale population-based data to investigate the association between vitamin D levels and headache risk in children and adolescents aged 6 to 19 years and to analyze the possible mediating effect of BMI on this relationship. The aim of this study was to explore the complex association between vitamin D levels and headache. We analyzed 2 cycles of the NHANES dataset, which included a total of 7066 children and adolescents aged 6 to 19 years. Multivariate linear regression models, subgroup analyses and smoothed curve fitting were used to investigate the associations between vitamin D levels and headache, and the potential mediating role of BMI was explored. The results of the present study revealed a evident negative correlation between vitamin D levels and headache risk in children and adolescents, a finding that was further supported by smoothed curve fitting. Notably, this negative correlation was stronger in the female and adolescent groups. The results of the mediation analysis revealed that BMI had a evident mediating effect, with a mediation ratio of 20.94%. This study found that lower vitamin D levels were associated with a higher likelihood of headache in children and adolescents, and that BMI may play a partial mediating role. This finding provides new strategies for the prevention and treatment of headache in children and adolescents. More prospective studies are necessary to further validate this association and its underlying mechanisms.
This study examined the impact of competition-related anxiety on psychological and behavioral parameters of Tunisian karate athletes. A total of 176 young Tunisian karate athletes (aged 16-25 years) with at least 1 year of training and competitive experience voluntarily participated in this study. Validated instruments were administered 1 week before and on the day of the competition, including the State-Trait Anxiety Inventory, the Pittsburgh Sleep Quality Index, the Brunel Mood Scale, and the International Physical Activity Questionnaire. Paired Wilcoxon signed-rank tests were used to compare changes over time, and multiple linear regression models were used to identify predictors of state and trait anxiety. Anxiety, mood, sleep, and physical activity changed from 1 week before to competition day (all P < .001). One week before, state anxiety was higher with tension (β = 1.22, P < .001), fatigue (β = 1.49, P < .001), and confusion (β = 1.14, P < .001); trait anxiety was higher with anger (β = 1.15, P < .001), depression (β = 1.38, P < .001), and fatigue (β = 0.42, P = .004), and lower with confusion (β = -0.36, P = .009). State anxiety was positively associated with sleep disturbances (β = 5.94, P < .001); trait anxiety with poorer subjective sleep quality (β = 2.87, P < .001) and longer sleep latency (β = 0.26, P < .001). Vigorous MET-minutes predicted lower state anxiety (β = -0.009, P = .02) and walking predicted lower trait anxiety (β = -0.007, P = .007). State anxiety increased with confusion (β = 1.47, P < .001) and decreased with vigor (β = -0.94, P = .003); trait anxiety increased with depression (β = 1.53, P < .001) and fatigue (β = 1.34, P < .001). Daytime dysfunction predicted higher state anxiety (β = 8.91, P < .001) and sleep latency predicted higher trait anxiety (β = 0.10, P = .031). Moderate MET-minutes predicted higher state anxiety (β = 0.008, P = .02). Increases in state anxiety aligned with higher tension (β = 0.93, P < .001), fatigue (β = 0.61, P = .004), and confusion (β = 1.89, P < .001), and decreases with depression (β = -0.54, P = .02). Increases in trait anxiety were driven by depression (β = 1.67, P < .001) and fatigue (β = 1.06, P < .001). Greater daytime dysfunction predicted increases in state anxiety (β = 9.28, P < .001), whereas longer sleep latency (β = 0.19, P < .001) and shorter sleep duration (β = -3.18, P < .001) predicted increases in trait anxiety; activity changes were not significant. Competition anxiety in young karate athletes is chiefly associated with mood disturbances and sleep parameters; implementing mood-regulation and sleep-focused strategies may reduce anxiety in youth combat sports.
Peripheral nerve stimulation (PNS) is an evolving therapy for treating chronic refractory pain; however, limited clinical evidence is available for the use of PNS for chronic low back pain in the spinal cord injured (SCI) patient. A patient, with an L1 complete SCI with a zone of partial preservation to S1 resulting in paraplegia and chronic low back pain, received bilateral L4 medial branch PNS. He had significant improvement of low back pain quantified by reductions in the Oswestry Disability Index and the Global Pain Scale, with additional benefits, including improved wheelchair sitting endurance and improved postural stability, at one-month and 2-month follow-up visits. Despite limited evidence, our findings suggest lumbar medial branch PNS is a safe and viable option for treatment of chronic low back pain in the SCI population, with additional benefits of efferent fiber stimulation leading to improved postural stability and sitting tolerance.
Repetitive noxious stimulation can increase perceived pain intensity, a phenomenon known as Temporal Summation of Pain (TSP), thought to reflect central sensitization via neuronal "wind-up" in the spinal cord. As neuronal wind-up occurs only at stimulation frequencies above 0.2 Hz, we have tested whether TSP also appears at two different frequencies using our recently developed TSP protocol in healthy volunteers. In a randomized crossover design, 30 healthy male participants (27±4 years) underwent two experimental sessions involving 90 repetitive heat stimuli applied to the forearm at individually determined pain tolerance temperatures. Stimuli were delivered using a thermode at either 0.4 or 0.15 Hz. Pain intensity was rated using a computerized visual analog scale (0-100). TSP was assessed via linear mixed-effects model (LMM), with pain intensity as the dependent variable. All participants finished the study. LMM revealed a significant main effect of stimulation frequency (F 1, 540=14.20, p<0.001), indicating TSP. Pain intensity was higher at 0.4 Hz compared with 0.15 Hz (β=14.77, 95 % confidence intervals (CI) 6.87-22.68, p<0.001). The presence of TSP at 0.4 Hz but not at 0.15 Hz aligns with previous findings on neuronal wind-up, supporting its reliance to central sensitization. These findings enhance our understanding of the physiological basis of TSP and offer a robust platform for future investigations into pain modulation and therapeutic intervention strategies.
Wearable technology holds promise for improving mental health care by enabling continuous, objective monitoring of physiologic parameters. Building on decades of psychophysiology research, wearables can provide an additional source of measurement for implementing measurement-based care in learning mental health systems. This review describes wearable use across inpatient and outpatient settings, identifying gaps and opportunities in clinical care and research. While widely studied in outpatient, wearables hold immense potential for in inpatient settings. Advancements needed include user-centered design, better understanding of complex populations and settings, and use of modern analytical methods to generate clinically actionable mental health insights for all.
Dominance hierarchies in fish are established through conflicts and lead to significant differences in stress physiology, behaviour, and immune function between dominant and subordinate individuals. This review explores the relationship between social stress within these hierarchies, individual variations in stress responses and cognitive bias towards stressful situations, and the impact of conflicts on future performance and interactions between stress and the immune system. Fish express divergent stress coping styles (proactive and reactive) that differ in the reactivity of the stress axes ending with the release of the major stress hormones (adrenaline and cortisol). Social stressors, like conflicts, are perceived differently by proactive and reactive fish, leading to varying levels of stress hormone release. The stress hormones interact with the immune system, changing individuals' ability to fight off pathogens. Pro-inflammatory cytokines highly activated in reactive individuals under stress can provide feedback to the monoaminergic system in the brain, resulting in depression-like, anxiety-like, or "sickness" behaviour. The review also discusses strategies for reducing social stress in fish and enhancing their overall health in aquaculture, while emphasising the importance of considering these factors in research settings to prevent data bias.
Fast-track and outpatient surgery have significantly reduced postoperative hospital stays across many surgical specialties. As a result, patients are increasingly discharged with strong opioid prescriptions, contributing to the global opioid crisis. Careful follow-up and opioid tapering are essential. While multidisciplinary Transitional Pain Services (TPS), involving pain specialists, psychologists, and physiotherapists, have shown promise, their widespread implementation is limited by costs and complexity. To address these barriers, we implemented a nurse-led TPS, supervised by a pain specialist and embedded within a multidisciplinary pain clinic. The aim of this study was to evaluate its effectiveness in clinical practice, including a mechanism-based treatment approach to postsurgical pain aimed at opioid tapering and optimizing the use of adjuvant analgesics. This observational cohort study included postoperative patients discharged with >20 mg oral oxycodone equivalents and/or those experiencing or at risk for neuropathic pain. Referred patients received telephone consultations by a nurse practitioner (NP) one to two weeks post-discharge. Each consultation included assessment of pain severity, neuropathic characteristics (using the first two items of the DN4 questionnaire), current analgesic use, and willingness to taper opioids. Patient education and motivational interviewing techniques were employed to support opioid tapering. Descriptive statistics and paired t-tests were used to analyze the data. Between June 2019 and July 2025, 243 patients were enrolled in the TPS. Following nurse-led counseling, 73 % of patients discontinued opioid use entirely, 23 % significantly tapered their dosage (from mean 101-43 mg oral oxycodone equivalent), and 4 % continued at the same dose. Anti-neuropathic medications were initiated in 22 % of patients. A nurse-led Transitional Pain Service is a feasible and effective approach to support opioid tapering in postoperative patients. In addition, early screening for neuropathic pain allows for targeted treatment. This model offers a scalable alternative to traditional multidisciplinary TPS programs.
The circadian rhythm system and sleep coordinate whole-body functions across the 24-h cycle, yet these rhythms progressively deteriorate with neurodegenerative diseases, including dementia. Growing evidence indicates that nicotinamide adenine dinucleotide (NAD+) interacts with the circadian system through multiple molecular pathways and that NAD+ levels decline with dementia. In this review, we synthesize current evidence on the bidirectional relationship between NAD+ metabolism and circadian regulation in several dementia disorders, emphasizing the key circadian pathways, the nicotinamide phosphoribosyltransferase-mediated salvage synthesis, the NAD+/sirtuins-dependent signaling, and the consumption of NAD+ by PARP1 and CD38. Finally, we also examine pharmacological and lifestyle strategies that target NAD+, including NAD+ precursors, modulators of NAD+ biosynthetic and depleting enzymes, timed light and activity exposure, structured exercise programs, and dietary interventions. Overall, we focus on the bidirectional interplay between NAD+ metabolism and circadian rhythm regulation in dementia, with particular emphasis on how this interaction influences sleep and cognitive phenotypes across different dementia subtypes. Trial Registration: ClinicalTrials.gov identifier: NCT05040321, NCT04430517, NCT06971224, NCT05500170, NCT04070378.