The sense of belonging is among the most fundamental psychological needs of an individual. Today, in addition to face-to-face interactions, social media platforms also fulfill this need and make it publicly visible. Social media posts of an individual, in particular, can be interpreted as a reflection of their tendency to express a sense of belonging. The current study aimed to examine the validity and reliability of the Turkish version of the Desire to Belong Publicly (DTBP) scale, which aims to explain individual tendencies to display belonging on social media. This research, comprised of three separate studies (N = 1046), collected data exclusively from Instagram users. Exploratory factor analysis was used in the first study, and confirmatory factor analysis was used in the second and third studies. Additionally, internal consistency, four-week test-retest reliability, convergent and discriminant validity were analyzed. The scale's relationships with social media usage habits, personality traits, social comparison orientation, and perceived ostracism were examined. The findings indicate that the Turkish form of the eight-item DTBP scale has a single-factor structure. The scale has high internal consistency (α = 0.93, ω = 0.93) and high test-retest reliability (r = .80, p < .001) measured at a four-week interval. The scale is related to, but conceptually distinct from, the general belongingness (GB). The CFA conducted in Study 3 indicated that the single-factor structure of the scale was appropriate. DTBP was also positively correlated with social comparison orientation, excessive Instagram usage, and perceived ostracism, and negatively correlated with conscientiousness. This study provides evidence for a distinct individual-difference construct related to the public display of belonging on social media. The findings suggest that DTBP is associated with several psychosocial variables, including excessive Instagram use, personality traits, perceived ostracism, and social comparison orientation. This scale may contribute to future theoretical and applied studies on understanding digital self-presentation and visible belonging behaviors among Instagram users and within image-based social media contexts.
Postpartum Post-Traumatic Stress Disorder (PTSD) is a significant mental health concern for postpartum women. In Malawi, there were no data showing the prevalence of Postpartum Post-Traumatic Stress Disorder and no validated Chichewa tool for assessing Postpartum PTSD. City Birth Trauma Scale (CityBiTS) is a tool that is used to assess Postpartum PTSD. CityBiTS is the best choice because it was developed specifically to measure trauma related to childbirth, tailors to the unique psychological, physical and emotional experiences of postpartum women. The tool also adheres to DSM-5 Criteria and has been validated across cultures which has shown high reliability and credibility to be used in clinical practice and research. The study aimed at assessing the diagnostic accuracy of the Chichewa Version City Birth Trauma Scale at Postnatal clinics in Lilongwe District, Malawi. The study's objectives were; to determine the prevalence of postpartum PTSD and establish the psychometric properties of Chichewa Version of the City Birth Trauma Scale in Malawi. It was a cross-sectional study conducted at two hospital facilities and these were Bwaila Hospital and Area 25 Health Centre postnatal clinics in Lilongwe District, Malawi. English City Birth Trauma Scale was translated into Chichewa version and adapted. A total of 384 postnatal mothers were selected by systematic random sampling technique. Data was analysed by SPSS version 23 and Sensitivity Analysis was done to examine the psychometric properties. The prevalence of Postpartum PTSD was 22.6% [95% CI 18.8% - 27.1%] on Structured Clinical Interview for Diagnostic Statistical for Mental Disorders Version 5 and 10.9% [95% CI 7.9% - 14.5% on City Birth Trauma Scale. The following psychometrics were established: Cronbach's alpha 0.780, ROC 0.872, sensitivity 81.6% [95% CI 71.8%-89.1%], specificity 78.9% [95% CI 73.8%-83.4%], Positive Predictive Value 53.0% [95% CI 47%-58.9%], Negative Predictive Value 93.6%, [95% CI 90.4%-95.8%] optimum cut-off score > 23, Youden Index 0.605, Exploratory Factor Analysis for variance 65.6%.Factor 1 which are birth-related symptoms and factor 2 which are general symptoms emerged and all items loaded except items 10 and 17 and Convergent Validity at 0.65. The prevalence rate of Postpartum PTSD and Psychometric properties were consistent with other studies affirming its utility. The study determined the information on prevalence of Postpartum PTSD. It further demonstrated that Chichewa Version City Birth Trauma Scale is a reliable, accurate and valid tool for screening Postpartum PTSD with good psychometric properties for clinical practice and research.
Polyp segmentation in colonoscopy images plays a critical role in the early detection and treatment of colorectal cancer. Although deep learning-based segmentation models have achieved remarkable success, their performance is often limited by variable imaging protocols or unseen datasets from different endoscopic devices. To address this challenge, unsupervised domain adaptation (UDA) methods have emerged as a promising solution, leveraging labeled source data and unlabeled target data to bridge the domain gap. However, existing UDA models suffer from two key limitations. First, they entangle domain-invariant and domain-specific features, making it difficult to identify which representations should transfer across domains. Second, they rely on single-scale features that fail to capture the extreme size variations observed in polyps, which range from tiny flat lesions to large protruding masses. As such, we propose FD-MSP, a feature decoupling network with multi-scale prototypes for cross-domain polyp segmentation. The core contribution is a structural redesign of the UDA pipeline that explicitly decouples feature distribution alignment from multi-scale semantic prototype learning, rather than entangling them in a single objective. This redesign is realized through four tightly-coupled components: (i) a dual-stream shallow-encoder decoupling module that separates domain-invariant polyp signatures from equipment-dependent variations through the joint effect of adversarial alignment on both low-level features and output predictions and a pixel-wise orthogonality regularizer between source-fed and target-fed shallow features; (ii) an online pseudo-fusion adapter that blends offline soft labels with current full-image predictions under class-wise confidence gating; (iii) a multi-scale grouped prototype layer (three groups of seven prototypes) that captures polyp patterns at multiple granularities through dilated convolutions with progressively expanding receptive fields; and (iv) a dual-branch gated head that adaptively fuses convolutional and prototype predictions at inference. Experimental results on three public colonoscopy datasets showed that FD-MSP offers consistent improvements over existing UDA methods for polyp segmentation performance in the target domain.
Cognitive impairments in Parkinson's disease (PD) commonly affect executive function, attention, and visuospatial abilities. These deficits may precede motor symptoms and are often undetected by screening tools such as the Standardized Mini-Mental State Examination (SMMSE). The utility of the Dynamic Lowenstein Occupational Therapy Cognitive Assessment-Geriatric Version (DLOTCA-G) has not been evaluated in older adults with PD. This study aims to investigate the effectiveness of DLOTCA-G in detecting cognitive deficits in PD patients with and without cognitive impairment. In this prospective controlled study, 90 participants aged 65 and above were recruited: 30 PD patients with cognitive impairment (PD-CI), 30 PD patients without cognitive impairment (PD-NCI), and 30 healthy controls. All participants underwent cognitive assessment using SMMSE and DLOTCA-G. The total SMMSE score and eight subscales of the DLOTCA-G were analyzed. Except for the spatial perception score, there was a statistically significant difference between the groups in all DLOTCA-G subscales. The PD-CI group had significantly lower awareness and visuomotor construction scores than the PD-NCI and healthy groups (p < 0.01). The PD-NCI group showed significantly lower awareness and visuomotor construction scores than the healthy group (p < 0.01). Total SMMSE scores showed a moderate positive correlation with orientation, praxis, visuomotor construction, and thinking operations (p < 0.01). In the Parkinson's group (n = 60), SMMSE Orientation correlated strongly with DLOTCA-G Orientation, Visuomotor Construction, and Awareness (p < 0.001). SMMSE Attention/Calculation and Language showed moderate associations with praxis and visuomotor domains (p ≤ 0.001; Table 4). The results indicate that DLOTCA-G subscales associated with executive function are impaired in individuals with PD, even in the absence of cognitive impairment. These findings suggest that DLOTCA-G may offer a more differentiated cognitive profile than SMMSE across multiple domains, although its comparative sensitivity and diagnostic accuracy require further validation in studies using comprehensive neuropsychological references. The study was retrospectively registered (registration number NCT06131619), prospective registration prior to participant enrollment was not completed due to logistical reasons. Protocol adherence was maintained throughout the study.
Obstructive sleep apnea (OSA) is common yet frequently underdiagnosed, partly because overnight polysomnography (PSG) is logistically burdensome and access to specialized testing is limited. We aimed to develop machine-learning models for OSA risk screening using multimodal digital phenotyping from consumer-grade wearable devices, smartphone-based assessments, and clinical scales. We enrolled 338 participants and collected data over four weeks. After preprocessing, 107 features were derived from wearable-derived physiological and activity measures, smartphone-based records, and questionnaire-based clinical risk profiles, and used to classify high- versus low-risk OSA groups defined by the Berlin Questionnaire. Across multiple model configurations, predictive performance was high, with the best-performing model achieving an AUC of up to 0.94 and an F1 score of 0.80 in the internal validation set. Consistently influential predictors included body mass index, Insomnia Severity Index score, Smartphone Overuse Screening Questionnaire score, resting heart rate, and heart rate recovery. These findings suggest that multimodal digital phenotyping from accessible consumer technologies may support scalable pre-screening for OSA risk in real-world settings. Further validation against PSG-confirmed OSA outcomes is needed.Trial Registration: Clinical Research Information Service (CRIS) KCT0009175 (Registration data: Feb-15-2024) (https://cris.nih.go.kr/cris/search/detailSearch.do?search_lang=E&focus=reset_12&search_page=M&pageSize=10&page=undefined&seq=26133&status=5&seq_group=26133).
Gastrointestinal (GI) diseases represent a major global health burden, making accurate and early diagnosis critical for improved clinical outcomes. We propose a dual-backbone convolutional framework that integrates EfficientNet-B0 and EfficientNet-B4 to jointly capture fine-grained local details and high-level global context in endoscopic images. The two feature streams are fused through residual learning with channel expansion-reduction and 1×1 convolutions, followed by a Convolutional Block Attention Module (CBAM) that adaptively emphasizes diagnostically relevant regions while suppressing background noise. To improve generalization and training stability, MixUp augmentation and Stochastic Weight Averaging (SWA) are employed, and a dropout-regularized classifier is used to mitigate overfitting. Experimental results demonstrate that the proposed method achieves an overall accuracy of 84.11% and a Macro-F1-score of 72.11%, consistently outperforming single-backbone EfficientNet variants and other baseline models, validating the effectiveness of the proposed architecture in both performance and efficiency.
Consistent with WHO guidance Zimbabwe is transitioning from annual single visit screen-and-treat using visual inspection with acetic acid and cervicography (VIAC) to HPV testing every three years to screen women living with HIV (WLHIV) for cervical cancer. We administered a questionnaire at three public-sector facilities in Zimbabwe to understand reasons why WLHIV accept or decline VIAC and preferences for implementation of HPV testing. A total of 451 WLHIV completed the questionnaire, of whom 414 (91.8%) accepted VIAC screening and 37 (8.2%) declined screening. Close to 50% of the 37 women who declined screening indicated a preference for HPV testing. The majority of WLHIV (76.3%) had known their HIV positive status for ≥ 5 years and nearly all (99.8%) were on antiretroviral therapy. Among the 414 WLHIV accepting VIAC screening, 323 (78.0%) were re-screening, and 91 (22.2%) were screening for the first time. WLHIV accepting VIAC re-screening were motivated by healthcare workers helping them feel secure about their health (45.8%), compliance with annual screening recommendations (39.6%), and encouragement from a healthcare worker (8.0%). Those accepting VIAC screening for the first time were motivated by encouragement from a healthcare worker (39.6%), compliance with annual screening recommendations (38.5%), and helping them feel secure about their health (17.6%). When asked what screening approach they would prefer in the future, the majority of women accepting re-screening (70.3%) and first-time screeners (89%) indicated a preference for continuing with VIAC screening. The 93 WLHIV with a screening history who indicated a preference for HPV testing were evenly split between preferring provider-collected sampling (13.9%) and self-collected sampling at the health facility (13.6%). Fear of physical discomfort of a pelvic exam (54.1%), worry about the screening result (13.5%), and perceived side effects of VIAC (10.8%) were the most common reasons given by the 37 WLHIV who declined VIAC. Facilities transitioning to HPV testing will need to incorporate client-centered education that acknowledges existing individual commitment to VIAC, explains the benefits of HPV testing, and offers HPV self-sampling for WLHIV who are hesitant to undergo a pelvic exam.
Lens epithelial cells (LECs) have a critical role in nutrient transport, ion balance, and the synthesis of essential molecules required to preserve the lens's transparency. We hypothesize that lens epithelial cell density (LECD) may be correlated with the formation and severity of cataracts. Studying this relationship is limited by current quantification methods. This study aimed to develop an AI-driven model capable of automatically performing epithelial cell (LEC) counts in excised capsules, including density, distribution, and determining factors that affect LECD. We developed an AI-based software that leverages deep learning algorithms to automate the enumeration of LECs from light micrographs of harvested anterior lens capsules. To evaluate the performance and reliability of our AI model, we compared its results against traditional manual cell counting methods. Validation analyses included repeated-measures ANOVA, Bland-Altman analysis, mean absolute percentage error (MAPE), the intraclass correlation coefficient (ICC), and a comparison against inter-observer agreement between two independent expert observers to quantitatively assess agreement between AI-generated cell counts and manual enumeration. Participants were patients with age-related cataracts scheduled for phacoemulsification. Over 43,000 individual cellular targets were analyzed across 20 validation images. The AI-driven software showed excellent agreement with consensus manual counts (98.1% accuracy; MAPE 1.87%, 95% CI 1.27-2.47%; Pearson r = 0.99; ICC 0.994, 95% CI 0.982-0.997), tighter than the agreement between the two expert observers themselves (MAPE 3.74%; ICC 0.972). The AI tool provides a rapid, objective, and repeatable method for LECD analysis.
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Cold-water corals (CWCs) are key ecosystem engineers that create complex three-dimensional habitats much like tropical reefs, but in deep, cold seas. However, like other reef-building systems, they are increasingly threatened by climate change and ocean acidification. CWC communities in the Mediterranean Sea may be especially vulnerable because these waters absorb more atmospheric CO2 than the global ocean, making it a mesocosm that mirrors broader global trends affecting marine life. Since calcification is energetically costly and likely becomes even more demanding as pH and carbonate ion availability decline, understanding how the decrease in aragonite saturation state (Ωarag) affects biomineralization is essential for predicting the future of these corals. Here, we investigated skeletal structural and compositional changes of the scleractinian CWC Desmophyllum dianthus along an Ωarag gradient in the Mediterranean Sea using specimens collected between 400 and 1200 m depth. Our findings indicate that skeletal porosity increases at the macro-scale with decreasing Ωarag, while micro- and nano-scale structural and compositional features remained unaffected. The persistence of micro- and nano-scale skeletal features across an 800 m depth gradient suggests that D. dianthus maintains tight biological control over mineralization at these scales, even as Ωarag declines. This control does not extend to the macro-scale, where increasing porosity alters the skeleton's overall architecture under lower Ωarag. D. dianthus thus appears to preserve the fundamental "building blocks" of its skeleton while changing its larger-scale structure, a decoupling that may make macro-scale porosity an early marker of acidification stress in CWCs.
Immune-inflammatory dysregulation is increasingly implicated in the pathogenesis of autism spectrum disorder (ASD). Umbilical cord blood mononuclear cells (UCB-MNCs), with their immunomodulatory effects, represent a promising therapeutic avenue by potentially alleviating neuroinflammation. This study aimed to evaluate the safety and efficacy of multiple intravenous infusions of allogeneic UCB-MNCs in children with ASD and peripheral immune dysregulation. In this single-center, double-blind, randomized, placebo-controlled trial (RCT), 34 children (aged 3 to 8 years) diagnosed with ASD were randomly assigned to receive intravenous infusion of allogeneic UCB-MNCs (3 × 10⁸ cells per infusion) (n = 17) or placebo (n = 17) four times with 1-week interval, alongside their existing rehabilitation therapy, and followed up for 13 weeks. The primary endpoint were the Total score of the Social Responsiveness Scale-2 (SRS-2). Additional endpoints was changes of the five domains of the SRS-2, the Vineland Adaptive Behavior Scales-3 (Vineland-3), the Childhood Autism Rating Scale (CARS), Aberrant Behavior Checklist (ABC), Swanson, Nolan, and Pelham Rating Scale-IV (SNAP-IV), Self-Rating Anxiety Scale (SAS) and safety. At final follow-up, the UCB-MNCs group demonstrated a significantly greater reduction in the SRS-2 Total scores (LS Mean Difference = - 6.03, 95% confidence interval [CI]: - 11.93 to - 0.14, P = 0.045) and Social Cognition domain (LS Mean Difference = - 9.95, 95% confidence interval [CI]: - 15.90 to - 4.00, P = 0.002) scores compared to the placebo group. No major allogeneic UCB-MNCs transplantation-related adverse events occurred. Allogeneic UCB-MNCs transplantation demonstrated preliminary safety and potential efficacy in improving specific aspects of symptoms in children with ASD and peripheral immune dysregulation. Trial registration This study was registered on ChiCTR.org.cn (Identifier: ChiCTR2400082762). Date registered 12 April 2024. https://www.chictr.org.cn/index.html.
Most studies confirm the effectiveness of virtual reality (VR) in alleviating pain and fear during pediatric venipuncture, with limited evidence regarding physiological stress markers and dynamic assessment. This study aims to investigate the effects of VR technology on pain, fear, and physiological responses in children, as well as family satisfaction during intravenous cannulation. This single-blind randomized controlled trial was conducted in the Pediatrics Department of Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China. A total of 188 children requiring intravenous cannulation procedures and their families were allocated into: the control group (n = 96), which received the conventional verbal comfort; and the experimental group (n = 92), which wore VR headsets. The primary outcomes were dynamic fear/pain scores assessed by nurses and self-reported by patients, which were surveyed using the Children's Emotional Manifestation Scale (CEMS) and the Children's Fear Scale (CFS)/the Face, Legs, Activity, Crying, and Consolability scale (FLACC) and the Wong-Baker FACES Pain Rating Scale (Wong-Baker), respectively. The secondary outcomes were dynamic heart rate (HR) and peripheral oxygen saturation (SpO2) measurement, and family satisfaction levels. The pre-specified time points were pre-intervention, immediately post-intervention, at tourniquet application, at venipuncture, and one minute after venipuncture. Results were reported following the Consolidated Standards of Reporting Trials 2025 guidelines. VR significantly reduced children's fear at two pre-venipuncture time points (nurse-assessed CEMS and child-reported CFS; partial η2 = 0.072 and 0.053, both p < 0.05). There were no significant group effects in nurse-assessed FLACC and child-reported Wong-Baker pain scores across three venipuncture time points. However, a significant time-by-group interaction was observed for nurse-assessed FLACC scores (partial η2 = 0.028, p = 0.006). Notably, nurse-assessed FLACC scores were lower than child-reported Wong-Baker scores in both control and experimental groups (Mean Diff.=-1.04 to -2.10, all p < 0.001). The dynamic changes in HR and SpO2 across five time points were lower within the experimental group (partial η2 = 0.106 and 0.045, both p < 0.01). Partial correlation analysis revealed that family satisfaction responded to children's pain, fear, and physiological stress in a "process-sensitive" pattern in the control group but an "outcome-oriented" pattern in the experimental group. In this trial, VR distraction effectively reduced procedural fear (but not pain) during venipuncture. However, the nurse assessment appears to suggest that the effects of VR distraction and conventional intervention on pain experience may vary over time. These findings underscore the importance of multidimensional pain/fear assessment in pediatrics. Our study confirms that VR distraction can significantly reduce fear in children undergoing intravenous cannulation, though pain scores were not significantly lowered. Multidimensional assessment (including subjective fear measures) is therefore important. VR may improve the patient and family experience of painful procedures. We recommend further trials with larger samples to confirm these findings and refine VR interventions. Chinese Clinical Trial Registry, ChiCTR2500113849 (Registration Date: Dec. 3, 2025; Retrospectively registered).
Lumbar spondylolisthesis is a clinically important cause of chronic low back pain, activity limitation, and reduced functional capacity. Exercise-based physiotherapy is widely recommended for conservative management, yet uncertainty remains regarding the added value of targeted core stabilization and hip-related stretching strategies in this population. Abdominal hollowing is intended to improve deep trunk muscle activation and lumbopelvic control, whereas piriformis stretching may reduce posterior hip tightness and movement-related discomfort. This trial aims to evaluate whether adding abdominal hollowing and piriformis stretching exercises to a standardized conventional physiotherapy programme improves pain, functional disability, and kinesiophobia in adults with low-grade lumbar spondylolisthesis. This study is a two-arm, parallel group, assessor-blinded randomized controlled superiority trial. Seventy-two participants aged 18 to 65 years with radiologically confirmed lumbar spondylolisthesis of Meyerding grade I or II, chronic localized low back pain of more than 3 months, and a baseline pain intensity of more than 3 on a 10-point Visual Analogue Scale will be recruited from the Musculoskeletal Physiotherapy Unit of the Centre for the Rehabilitation of the Paralysed, Savar, Bangladesh. Recruitment is planned from April 2026 to June 2026. Participants will be allocated in a 1:1 ratio using a computer-generated block randomization sequence with concealed allocation. Both groups will receive a standardized conventional physiotherapy programme three times weekly for 6 weeks. The experimental group will additionally receive abdominal hollowing and piriformis stretching exercises. The primary outcome will be pain intensity measured by the 10-cm Visual Analogue Scale immediately after the 6-week intervention. Secondary outcomes will include functional disability measured by the Oswestry Disability Index, kinesiophobia measured by the Tampa Scale for Kinesiophobia, and all outcome measures assessed at 4-week follow-up. Data will be analysed according to the intention-to-treat principle using linear mixed effects models, with effect estimates reported alongside 95% confidence intervals. This trial will determine whether adding targeted core stabilization and piriformis stretching to a standardized physiotherapy programme produces superior short-term clinical outcomes in people with lumbar spondylolisthesis. The findings may inform conservative rehabilitation strategies for this population, particularly in resource-limited clinical settings. Clinical Trial Registry India (CTRI), CTRI/2025/07/089927. Registered prospectively on 01 July 2025.
This study assesses ecosystem services (ESs) capacity and landscape sensitivity to support the management of spatial and temporal changes in the flood-prone lowlands of Düzce Province, Türkiye, which is undergoing rapid urbanization. ESs, defined as the direct and indirect benefits that nature provides to people, are increasingly threatened by land use/land cover (LULC) changes, urban sprawl, and environmental degradation. Given the region's high exposure to natural hazards such as floods, landslides, and erosion, understanding the interaction between ES capacity and landscape sensitivity is crucial for disaster risk reduction and sustainable planning. The study employs a hierarchical framework across spatial, institutional, and temporal (SIT) scales: (i) LULC changes derived from CORINE land cover data (1990-2018) were analyzed to identify spatial patterns of ES capacity decline and emerging high-risk zones. (ii) At the institutional scale, an Analytic Hierarchy Process (AHP) and an ESs-LULC matrix were used to prioritize services through expert assessments from local agencies. (iii) At the temporal scale, 2050 population projections were used to model future demand for ESs and urban sprawl risks. (iv) These outputs were spatially integrated to generate sensitivity maps and inform adaptive planning strategies. The findings indicate that ESs capacity is declining in areas increasingly affected by urban encroachment, industrial development, and flood-related risks. This integrated approach highlights the importance of using spatially explicit, stakeholder-informed assessments to enhance local resilience and support climate-adaptive and hazard-responsive land-use planning.
Despite extensive research on adherence in first-episode psychosis (FEP), reliance on self-report or clinician judgment has limited accuracy and obscured nuanced clinical associations. This longitudinal study examined the predictive value of psychopathology, insight, and functioning for objectively measured treatment adherence across a one-year follow-up using therapeutic drug monitoring (TDM). Seventy-eight FEP patients were assessed at baseline, 2 months, and 12 months. Clinical measures included the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Negative Symptoms (SANS), Social and Occupational Functioning Assessment Scale (SOFAS), and the Schedule for the Assessment of Insight-Expanded version (SAI-E). Adherence was defined by comparing plasma antipsychotic concentrations to prescribed doses according to international consensus guidelines. Generalized linear mixed models (GLMMs) were used to model time-dependent associations. While overall adherence declined, time alone was not a significant predictor. Instead, current positive symptom severity (approximately 4-5% lower odds of adherence per BPRS point) was associated with lower odds of adherence, while prior non-adherence predicted subsequent adherence. In contrast, insight, negative symptoms, and functioning showed no consistent association with adherence. A marginal association between improved functioning and better adherence was observed at 12 months. Adherence in FEP appears to fluctuate in relation to current clinical state rather than follow a stable linear pattern. These findings highlight the value of objective TDM monitoring and early intervention, supporting predictive models that incorporate evolving symptom patterns rather than static baseline measures. Clinical trial number: not applicable.
Diabetes mellitus is a chronic condition that requires consistent adherence to treatment, regular self-care, and adequate knowledge of the disease to prevent complications and improve quality of life. However, many patients struggle to maintain optimal adherence and integrate self-care into their daily routines. Nowadays, many diabetes self-management modalities have emerged as a promising approach to address these gaps. This randomized controlled study evaluated the effect of a structured peer support program on medication adherence, self-care practices, and diabetes-related knowledge among patients with diabetes who attended follow-up at a tertiary hospital. A randomized controlled trial was conducted on 97 (intervention group = 48, control group = 49) adults with diabetes who were attending follow-up at Ayder Comprehensive Specialized Hospital (ACSH). Participants were randomly assigned to either a peer-support intervention group or a control group and followed for six months. The intervention comprised three structured peer-led sessions that focused on self-care, medication adherence, and diabetes knowledge. Outcomes were measured at baseline and follow-up using the Morisky Medication Adherence Scale (MMAS-8), adopted Diabetes self-care Activities (SDSCA) scale, and diabetes knowledge test (DKT). Data analysis was performed using chi-square tests, paired-sample t-tests, and independent-sample t-tests to compare baseline characteristics and evaluate intervention effects. Difference-in-differences (DiD) analysis was used to compare the intervention and control groups across outcome variables. Compared with the control group, participants in the intervention group demonstrated significant improvements across all outcome measures. Medication adherence increased by a net difference-in-differences estimate of (DiD = + 1.5 points, p < 0.001) on the MMAS-8 scale. Self-care practices improved by (DiD = + 1.3 days per week of recommended behaviors, p < 0.001). Diabetes knowledge scores also showed substantial gains, among both the insulin users (DiD = + 4.9-point, p < 0.001) and non-insulin users (DiD = + 3.4-points, p < 0.001) of the intervention group compare to controls. Integrating structured peer-support interventions into routine diabetes care may provide a practical approach to improving patient outcomes while optimizing limited healthcare resources in low-resource settings. Future research should evaluate the sustainability, scalability, and cost-effectiveness of peer-support education model, together with their long-term impact on quality of life.
Workplace incivility is a pervasive challenge in nursing, yet its sources, correlates, and consequences remain underexplored in Saudi Arabia. Saudi Arabia's nursing workforce is among the most internationally diverse in the world and operates within a rapidly evolving healthcare system marked by hierarchical structures and high turnover rates. This study examined the level of workplace incivility experienced by nurses in Saudi Arabia, identified the demographic and professional factors associated with exposure to incivility, and investigated the associations among incivility, work-related quality of life, and turnover intentions. A quantitative cross-sectional survey design was employed. A convenience sample of 278 nurses working in hospital settings across Saudi Arabia was recruited through online platforms between September 30, 2025 and January 6, 2026. Data were collected using three validated instruments: the Nursing Incivility Scale, the Work-Related Quality of Life scale, and the Anticipated Turnover Scale. Data analysis included descriptive statistics, independent-samples t-tests, one-way ANOVA with post hoc comparisons, Pearson correlation analysis, and hierarchical multiple regression. The majority of participants (84%) reported moderate to high levels of workplace incivility; given recruitment through convenience sampling, this figure is best interpreted as an upper-bound estimate within a self-selected sample. The highest incivility scores were observed for patient and family sources, followed by nurse colleague sources. Younger nurses and those with fewer years of experience reported significantly higher levels of incivility. Nationality was a significant differentiator, with Saudi nurses reporting higher incivility than Arab nurses. Married nurses reported lower levels of incivility than single nurses. Workplace incivility was significantly and negatively associated with work-related quality of life and positively associated with turnover intentions. In the hierarchical regression analysis, work-related quality of life explained substantial additional variance in turnover intentions beyond incivility alone, after which the direct effect of incivility was no longer significant. Workplace incivility is prevalent among nurses in Saudi Arabia and is associated with poorer work-related quality of life and higher turnover intentions. The findings suggest that work-related quality of life may account for the relationship between incivility and turnover. Multilevel interventions targeting patient and family incivility, peer dynamics, and organizational culture are needed to protect nurse well-being and support workforce retention in the Saudi healthcare system.
Paramedics in emergency medical services (EMS) work in high-demand environments in which occupational well-being is closely linked to patient safety and workforce sustainability. While transformational leadership has been associated with positive staff outcomes in health care, evidence regarding its associations with work engagement and occupational well-being in prehospital EMS remains limited. This study examines transformational leadership in Finnish EMS in relation to paramedics' work engagement and occupational well-being, including whether the association between transformational leadership and occupational well-being is statistically consistent with an indirect pathway involving work engagement. A cross-sectional online survey was conducted among 322 Finnish paramedics working in EMS at basic or advanced levels. Transformational leadership was assessed using the 43-item Transformational Leadership Scale, work engagement using the Utrecht Work Engagement Scale (UWES-9), and occupational well-being using a single-item self-rated numeric scale (4-10). Descriptive statistics, Pearson correlations, and hierarchical multiple regression analyses were conducted, adjusting for age, gender, education level, professional title, and years of EMS experience. Bootstrap resampling (5,000 samples) was used to examine whether the association between transformational leadership and occupational well-being was statistically consistent with an indirect pathway involving work engagement. Transformational leadership had a mean score of 2.75 (SD = 1.03, range 1-5). Leadership ethics received the highest ratings, whereas feedback and rewards were rated lowest. In multiple regression analyses, transformational leadership was positively associated with work engagement (β = 0.437, p <.001) and occupational well-being (β = 0.501, p <.001) after controlling for demographic factors. Work engagement was positively associated with occupational well-being (p <.001). When work engagement was added to the model, the association between transformational leadership and occupational well-being decreased but remained statistically significant, suggesting that the association was statistically consistent with an indirect pathway involving work engagement. Transformational leadership was positively associated with work engagement and occupational well-being among Finnish paramedics in EMS. The association between transformational leadership and occupational well-being was statistically consistent with an indirect pathway involving work engagement. However, causal or mediational conclusions cannot be drawn due to the cross-sectional design. From a health services perspective, the findings suggest that leadership may represent a key organizational resource for supporting workforce well-being and performance in high-demand EMS systems.
Combat athletes face unique psychological demands, and stress may influence both their cognitive experiences and psychological well-being. This study aimed to examine the mediating role of mental fatigue awareness in the relationship between perceived stress and psychological well-being among combat athletes, thereby contributing to a clearer understanding of a potential cognitive mechanism linking stress to well-being in this population. A total of 303 combat athletes voluntarily participated. Participants completed the Perceived Stress Scale, Mental Fatigue Awareness Scale, and Psychological Well-being Scale. Statistical analyses assessed the direct effects of perceived stress on psychological well-being, the effect of stress on mental fatigue awareness, and the potential mediating role of mental fatigue awareness. Perceived stress significantly increased mental fatigue awareness (b = 0.732, SE = 0.064, β = 0.549, p = 0.001) and directly decreased psychological well-being (b = - 0.488, SE = 0.166, β = - 0.191, p = 0.004). Mental fatigue awareness negatively affected psychological well-being (b = - 0.374, SE = 0.124, β = - 0.195, p = 0.003) and partially mediated the relationship between stress and well-being (indirect effect: b = - 0.274, SE = 0.115, β = - 0.107, p = 0.003; 95% CI = - 0.504 to - 0.049). Perceived stress was associated with psychological well-being both directly and indirectly through increased mental fatigue awareness. These findings suggest that mental fatigue awareness may represent a relevant cognitive pathway linking stress perceptions to well-being. Accordingly, stress management and strategies aimed at regulating mental fatigue may be considered as potentially beneficial components in efforts to support psychological well-being among combat athletes.
This study aims to design, develop, and evaluate the feasibility of a mobile chemotherapy drug guide (ChemoNurse) tailored for oncology nurses. The evaluation focused on feasibility, usability, and acceptability outcomes. ChemoNurse includes drug preparation, storage methods, administration routes, administration duration, dosage calculation, side effects, patient education, and symptom management. This feasibility study was conducted between August 1, 2023, and August 1, 2024, with 34 oncology nurses from the Turkish Oncology Nursing Society. The Standard Protocol Items: Recommendations for Interventional Trials checklist was utilized. The RE-AIM framework was used to guide the evaluation of early implementation outcomes, particularly feasibility, usability, and acceptability. The evaluation framework integrates usability, perceived usefulness, acceptability, and feasibility. The Information Form, ChemoNurse Evaluation Form, Mobile Application Usability Scale, Satisfaction Scale, and semi-structured interview form were used for data collection. The nurses' mean age was 32.79 ± 6.55 years, 91.2% female, and most had over ten years of professional experience. The evaluation of ChemoNurse's usability demonstrated high acceptance and perceived usefulness among oncology nurses. 94.1% of participants rated the application as easy to use, and 100% of participants reported that the content was understandable and clinically relevant. Additionally, 85.3% of participants considered the drug guide content clinically sufficient, and 91.2% confirmed that the application met their clinical needs. The application was perceived as cost-effective by all participants, and 97.1% of participants indicated they would continue using ChemoNurse in clinical practice. The Mobile Application Usability Scale results further supported these findings, with 91.2% of nurses scoring above 200 and a mean usability score of 246.76 ± 38.13. Preliminary evidence suggests that ChemoNurse is usable and acceptable for supporting oncology nurses' point-of-care access to chemotherapy information within this pilot sample; larger studies are needed to confirm its clinical impact. ChemoNurse demonstrated promising feasibility, usability, and acceptability within this pilot sample. Future studies with objective outcome measures are needed to evaluate its potential perceived usefulness and implementation feasibility in clinical practice.