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In this study, we aimed to understand and reduce the difference between self-report in a survey and the actual behavior. Thus, we investigated whether such a difference was caused by participants who engaged in insufficient effort responding (IER), which has been receiving increasing research attention. We collected and analyzed data of actual and self-reported smartphone game usage from behavior logs and survey responses including the items associated with the IER scale, respectively. The results confirmed a strong tendency of overreporting and low correlations between the behavior log and survey responses for IER participants. Although the distributions of survey responses differed between IER participants and others, those of the behavior log did not. In conclusion, when IER participants are excluded, the difference between the behavior log and survey responses reduces, but the distribution of the actual behavior remains the same without selection bias. [ABSTRACT FROM AUTHOR]

This paper discusses how the William G. Squires Library conducted a usability study on their LibGuides to identify student design preferences. The results of the study support previous research concerning best practices for LibGuide creation. This paper offers insight into how librarian-centric design hinders student success and provides suggestions for how to best develop a student-centric template design that offers consistency and increased user proficiency across all guides. [ABSTRACT FROM AUTHOR]

Policy makers and health professionals are grappling with the high costs of and demand for health care, questions of sustainability and value, and changing population demographics—in particular, ageing populations. Digital solutions, including the adoption of patient‐reported measures, are considered critical in achieving person‐centred and value‐based health care. However, the utility of patient‐reported measures and the data they produce may be subject to ageist beliefs, prejudices and attitudes, rendering these data ineffective at promoting improved patient experiences and outcomes for older adults. This article explores the ethical considerations raised in relation to patient‐reported measures and the digital agency of older patients. [ABSTRACT FROM AUTHOR]

Objectives: Regular retrospective review of glucose data is an important aspect of type 1 diabetes (T1D) management. Continuous glucose monitors (CGMs) facilitate retrospective review by capturing glucose data and generating standardized reports. However, only a minority of adults with T1D retrospectively review their glucose data, and adolescents are understudied. The objectives of this study were to determine the prevalence of self‐reported retrospective glucose data review by adolescents with T1D, determine factors associated with self‐reported retrospective glucose data review, and assess whether self‐reported retrospective glucose data review was associated with improved glycemia. Methods: We conducted a cross‐sectional survey of adolescents aged 12–18 years with T1D in conjunction with review of the associated electronic medical record, which included age, sex, date of diagnosis, clinic hemoglobin A1c (HbA1c), type of insurance, and CGM data. The survey included the Hypoglycemia Fear Survey (HFS) and questions regarding habits and attitudes associated with retrospective review. Results: 112 out of 218 eligible individuals completed the survey (51%). Fifty‐three percent of adolescents who completed the survey reported that they had engaged in retrospective glucose data review. Of these, 88% of individuals reported that they reviewed data regularly. Age, sex, race, type of insurance, and CGM use were not associated with retrospective review status. Self‐report of retrospective glucose data review was associated with improved glycemia as measured by HbA1c and time in range (TIR) compared to adolescents who indicated they do not review glucose data (p = 0.006 and p = 0.04, respectively). There was no difference in HFS scores between reviewers and nonreviewers including the behavioral subscale, worry subscale, and total score. Conclusions: Self‐report of retrospective glucose data review was associated with improved glycemia as measured by HbA1c and TIR. Adolescent‐initiated glucose data self‐review does not appear to be driven by fear of hypoglycemia (FoH). [ABSTRACT FROM AUTHOR]

Background: Harsh parenting has been recognized as a risk factor for adolescent anxiety; however, the underlying mechanisms of this relationship remain unclear, and it is unknown whether this relationship is influenced by different parental roles and living arrangements. This study aimed to investigate the mediating mechanisms between harsh parenting and adolescent anxiety symptoms using a multiple mediation model and to further compare specific roles of harsh parenting and distinguish between the living arrangements. Methods: A total of 3505 adolescents completed this survey, and 3295 adolescents (54.7% girls, Mage = 14.97 years) were included in the study. Participants completed self-assessments measuring harsh parenting, self-efficacy, school connectedness, Internet addiction, sleep problems, and anxiety. They were categorized into three groups based on living arrangements: living with both parents, only with the mother, or only with the father. Results: Correlational analyses revealed that both maternal and paternal harsh parenting were associated with increased anxiety symptoms. Structural equation modeling (SEM) mediation analyses and multigroup analyses showed that the independent mediating effects of school connectedness, Internet addiction, and sleep problems, as well as the sequential mediating pathways involving self-efficacy → school connectedness, self-efficacy → Internet addiction, and self-efficacy → sleep problems, vary across the adolescents' living arrangements in the association between maternal and paternal harsh parenting and adolescent anxiety symptoms. Conclusions: This study elucidated the mechanisms linking harsh parenting to adolescent anxiety symptoms and validated the effects of different parental roles and living arrangements. The findings provide important insights for developing targeted interventions to address anxiety symptoms in adolescents exposed to harsh parenting. [ABSTRACT FROM AUTHOR]

Background: Older adults with lower socioeconomic status are less likely to be physically active than those with higher socioeconomic status. To inform future intervention development, this review explored: [i] how effective are physical activity interventions at increasing levels of physical activity amongst older adults with lower socioeconomic status?; [ii] what factors are associated with the acceptability of physical activity interventions amongst older adults with lower socioeconomic status?; [iii] what are the implications for developing physical activity interventions for older adults with lower socioeconomic status? Methods: This mixed methods systematic review followed PRISMA guidelines. MEDLINE, CENTRAL, Embase, Scopus, Web of Science, PsycINFO, CINAHL, ASSIA and Sports Medicine and Education Index were searched up to May 2023, to identify quantitative, qualitative and mixed methods primary research studies measuring the effectiveness of and/or experiences of physical activity interventions for older adults (aged ≥ 65 years) with lower socioeconomic status. No limits on country were applied. Included studies were assessed for methodological quality using the Mixed Methods Appraisal Tool. Results were synthesised using a results-based convergent synthesis approach with narrative synthesis of quantitative findings and thematic synthesis of qualitative findings. Results: Thirty studies were included. Mixed effects were found for the effectiveness of physical activity interventions, with positive effects for increases in utilitarian walking (i.e. for transport) but not for leisure, mixed effects for objectively measured physical activity and no effects for self-reported total physical activity or muscle strengthening and flexibility activities. Engaging in physical activity interventions was perceived as offering many benefits, social familiarity was important to intervention acceptability and interventions were seen as more acceptable when they were compatible with the lifestyles of older adults with lower socioeconomic status. Conclusions: Future development of physical activity interventions for older adults with lower socioeconomic status should foster social connections, emphasise health benefits of physical activity, hold interventions in locations that are accessible and familiar to older adults with lower socioeconomic status, minimise costs to participants, employ individuals who share participant characteristics to lead interventions, and combine physical activity with other activities older adults with lower socioeconomic status already do to make more efficient use of time. Trial registration: PROSPERO CRD42023417312; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=417312. [ABSTRACT FROM AUTHOR]

Background: Community nurses (CNs) play an important role in supporting healthy lifestyles, including healthy eating behaviour of patients. However, many CNs do not incorporate healthy eating support in their daily routines to the fullest extent possible. This study aimed to explore (1) the associations between nurse-related behavioural determinants and self-reported healthy eating support practices of Dutch CNs and (2) CNs' need for additional knowledge. Methods: In this cross-sectional survey design, 244 Dutch CNs completed an online, self-administered questionnaire in October-November 2021. The 60 questionnaire items were related to CNs' characteristics, nurse-related determinants, healthy eating support practices (observing problems, having a conversation about patients' dietary behaviour, motivating patients to eat and drink healthier and supporting patients in goal setting) and the need for additional knowledge. The items on determinants and practices used a 5-point Likert scale. Adjusted prevalence ratios (PRadjusted) with 95% confidence intervals (95%CIs) were obtained for the associations between determinants and practices, using adjusted Poisson regression with robust variance estimations. Results: More CNs practiced observing problems (75%) and having a conversation (70%) than did motivating patients (45%) and supporting goal setting (28%) at least often. A more positive attitude (PRadjusted 1.8; 95%CI 1.5–2.2), greater self-efficacy (PRadjusted 1.3; 95%CI 1.1–1.5), greater motivation (PRadjusted 1.5; 95%CI 1.3–1.7) and better abilities (PRadjusted 1.4; 95%CI 1.2–1.6) were associated with a greater prevalence of supporting healthy eating at least often (vs. never to sometimes). Barriers were not associated with healthy eating support (PRadjusted 1.1; 95%CI 1.0-1.2). CNs especially desired more knowledge on diet in relation to cancer, gastrointestinal diseases, severe psychiatric diseases and dementia; methods for motivating patients to start and for supporting patients to sustain healthy eating; and dealing with patient autonomy. Conclusions: This study suggests that nurse-related behavioural determinants such as attitude, self-efficacy, motivation and ability should be addressed to improve CNs' competences in healthy eating support. In addition, based on self-reported need for additional knowledge, it is recommended to pay attention to evidence-based behaviour change techniques, dealing with patient autonomy, and diet in relation to cancer, gastrointestinal diseases, severe psychiatric diseases and dementia. Reporting method: The STROBE Statement was followed for reporting. [ABSTRACT FROM AUTHOR]

Background: Leadership in nursing is crucial for delivering high-quality healthcare and ensuring positive outcomes for patients, staff, and institutions. Many nurses in leadership positions lack formal training, which can compromise their effectiveness. This study aims to evaluate the effect of a leadership development program utilizing 360-degree feedback on head nurses' leadership practices. Methods: A true-experimental design was employed in three healthcare institutions. The study involved 80 head nurses (40 intervention, 40 control), 240 staff nurses, and 29 supervisors. The intervention group participated in a six-week leadership development program using 360-degree feedback. Data were collected pre- and post-intervention using the Leadership Development and 360-Degree Feedback Knowledge Questionnaire and the Leadership Practices Inventory (LPI). Results: The intervention group showed significant improvements in leadership knowledge and practices across all dimensions. Knowledge scores increased from 25.1 ± 8.8 to 93.0 ± 5.1 post-intervention, maintaining at 83.2 ± 7.1 at follow-up. Self-assessed leadership scores improved from 88.1 ± 6.0 to 97.5 ± 2.7, and 98.5 ± 2.0 at follow-up. Supervisor and staff assessments also showed substantial increases. Multiple linear regression analyses confirmed the strong positive impact of the intervention on leadership outcomes. Conclusion: The leadership development program using 360-degree feedback significantly enhanced head nurses' leadership knowledge and practices. The results suggest that such programs can improve leadership capabilities in healthcare settings, leading to better patient care and organizational performance. Future research should address group homogeneity and explore long-term impacts on patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study investigates the associations and mediating pathways between grip strength, cognitive function, and depression in middle-aged and elderly individuals in China. Methods: Utilizing data from the 2011 China Health and Retirement Longitudinal Study (CHARLS), we employed logistic regression and mediation analysis to examine the relationships and mediating factors between grip strength, cognitive function, and depression, while adjusting for potential confounders. Results: The study included 6,841 participants, of whom 1,734 (25.35%) exhibited symptoms of depression. Our findings indicate that weak grip strength is significantly associated with an increased risk of depression (OR: 1.57, 95% CI: 1.32-1.87) among the middle-aged and elderly population. Conversely, good cognitive function was found to be protective against depression (OR: 0.94, 95% CI: 0.93-0.95). Grip strength indirectly affected depression through cognitive function, accounting for 9.4% of the total effect (β = -0.008, 95% CI [-0.013, -0.004]). This mediating effect was 23.8% in men (β = -0.013, 95% CI [-0.020, -0.007]); and 23.2% in those aged 60 years and over (β = -0.015, 95% CI [-0.022, -0.009]). Conclusion: This study highlights that weak grip strength increases risk of depressive symptoms, and adequate cognitive function can mitigate the association between weak grip strength and an increased risk of depression among middle-aged and elderly individuals in China. Psychological care for elder adults with weak grip strength and poor cognitive function should be strengthened. [ABSTRACT FROM AUTHOR]

Background: Obesity has a significant impact on healthcare resources with limited accessible support available through the NHS. This service evaluation determines 24-month efficacy of referral to an open-group behavioral program by BMI category and socioeconomic status. Methods: This retrospective, longitudinal study examined weight outcomes of adults living in England referred by healthcare professionals to Slimming World during 2016 who recorded at least 1 weight change. Primary outcome was % weight change at 3, 6, 12, and 24 months. Socioeconomic status was measured using the Index of Multiple Deprivation (IMD). Data from a post-referral questionnaire investigated self-reported changes in dietary and activity behaviors. Results: Twenty-seven thousand five hundred sixty (15.6% male) records were analyzed. Mean (SD) age and BMI on joining were 48.6 (14.80) years and 37.1 (6.31) kg/m2; 91.7% had a BMI > 30 kg/m2. Mean (SD) % weight change was −5.6 (3.79), −7.1 (5.71), −7.5 (6.88), and −7.3 (6.88) at 3, 6, 12, and 24-months, respectively. At 24- months, differences in weight loss between BMI category were significant, ranging from 0.29% (35-<40 vs 40+) to 1.33% (25-<30 vs 40+). For IMD quintile only comparisons against Q1 and Q2 were significant, ranging between 0.36% (Q2 vs Q3) to 0.94% (Q1 vs Q5). Five thousand eight hundred sixty-two (21.2%) completed the post-referral questionnaire. There were no BMI category effects on dietary behaviors but changes in physical activity behaviors were lower within the higher categories albeit effect sizes were small (all ges < 0.001). IMD quintile influenced changes for sugary drinks, watching TV and avoiding moderate activity although effect sizes were small (all ges < 0.01). Conclusion: Following 12-week referral to a commercial weight management organization, a mean weight loss of over 7% was reported at 24-months. Adults with higher BMIs and a greater level of deprivation can benefit from the practical support offered as part of the referral, supporting weight loss and weight loss maintenance albeit with some inequality. [ABSTRACT FROM AUTHOR]

Background: In the socio-dental approach, the integration of normative oral health-related quality of life (OHRQoL) and behavioral propensity measures should be considered when assessing treatment needs and planning oral services. Therefore, this study aimed to evaluate the relationship between oral health impacts attributed to malocclusion and normative and self-perceived orthodontic treatment needs in adolescent patients and to determine the clinical, sociodemographic, and behavioral factors affecting their OHRQoL. Methods: This cross-sectional study was conducted using a convenience sample size of 105 adolescent patients aged 11–14 years who were referred to the Orthodontics Clinic in the Faculty of Dentistry, Istanbul. Data were collected using clinical examinations and a self-reported questionnaire, including the condition-specific Child Oral Impact on Daily Performances (CS-COIDP) attributed to malocclusion and sociodemographic, clinical, and behavioral factors. The index of complexity, outcome, and need (ICON), gingival index, and Decayed, Missing, Filled Teeth index was used to assess oral health status. Descriptive statistics and bivariate and multivariate regression analyses were used for the data analyses. Results: A total of 70 patients (66.7%) reported at least one impact. Furthermore, 47% of the adolescents had very difficult and difficult complexity grades. The most affected performances were "emotional (52.4%) and smiling (40%)". No significant differences were found in the total CS-COIDP scores according to caries experience; however, the gingival status was associated with the total OHRQoL. Lower tooth brushing frequency, increased malocclusion complexity, and subjective treatment need were the most important predictors of worse OHRQoL, accounting for 39.3% of the variance in the scores. (R2 = 0.422; p < 0.001) Conclusions: Oral health professionals should consider oral behaviors, malocclusion complexity, and subjective treatment need when planning orthodontic treatment plans. Integrating ICON, CS-COIDP, and behavioral assessment will help identify adolescents who should be prioritized for treatment. [ABSTRACT FROM AUTHOR]

Few empirical research has attempted to determine the impact of Intelligent Computer-Assisted Language Assessment (ICALA) in philosophy-based language instruction (PBLI) on critical thinking, self-evaluation, and academic resilience, despite the significant role that higher-order thinking skills play in influencing English as a Foreign Language (EFL) learners' cognition, including their learning processes. This research addresses this knowledge vacuum by examining how ICALA in PBLI influences the development of the four primary abilities associated with critical thinking, self-evaluation, and academic resilience. A quasi-experimental strategy was used in this study among 81 EFL learners. The participants were split into two groups: one to participate in the experiment and another to serve as a control. The books for both groups were revised or supplemented according to the underlying PBLI principles. The control group (CG) students were exposed to paper format assessment. In comparison, the experimental group (EG) attended ICALA. The statistical significance of the differences between the two groups was determined using multivariate analysis of variance (MANOVA). The results demonstrated that the learners in EG outperformed their peers in CG foreign language-speaking development. Moreover, they received better critical thinking, self-evaluation, and academic resilience results. [ABSTRACT FROM AUTHOR]

Background: Caring plays a vital role in nursing and serves as an indicator of quality. Nurse caring behaviors are directed towards patients' safety and wellbeing. Nurses' perceptions of caring behaviors are affected by different factors. Understanding the factors linked to how nurses perceive caring behaviors is crucial for enhancing the quality of care. The aim of this study was to examine the factors associated with nurses' perceptions of caring behaviors and gain a more comprehensive understanding. Methods: A multicenter sequential explanatory mixed-methods study was conducted among medical-surgical nurses at three referral hospitals in the Amhara region, Ethiopia. Quantitative data were collected using a pretested self-administered survey package including the Amharic version of the Caring Behaviors Inventory-16. Qualitative interviews using semi-structured, open-ended questions were conducted after the survey to complement and clarify the quantitative results, facilitating integrate through a connecting approach. A multiple linear regression model was used to examine the relationship between nurses' perceptions of caring behaviors and associated factors. The qualitative data was examined to find meaningful patterns using codebook thematic analysis. This method was deductive and followed the guidelines by Braun and Clarke, building on the findings from the quantitative results. Results: The overall mean of nurses' perceptions of caring behaviors was 4.75. The multiple linear regression analysis showed that female sex (b = 0.300, P = 0.004), age (b = 0.028, P = 0.001), nurse staffing (b=–0.115, P = 0.001), work-related stress (b = 0.298, P = 0.003), and job satisfaction (b=–0.254, P = 0.016) were associated with nurses' perceptions of caring behaviors. The codebook thematic analysis generated three themes, caring is universal and fundamental in nursing, impediments to provision of comprehensive care, and perception of the work conditions. The findings of the qualitative data complemented the results of the quantitative data. Conclusion: Discrepancies between nurses' expectations and the actual working environment may create uncertainty in care provision and impact quality-of-care. Strategies to harmonize the nurses' working environment should consider work-related factors. [ABSTRACT FROM AUTHOR]

Background: Blended learning, a pedagogical approach combining traditional classroom instruction with online components, has gained prominence in nursing education. While offering numerous benefits, student satisfaction with blended learning remains a critical concern. This study contributes to the existing literature by providing a comprehensive evaluation of the determinants influencing nursing students' satisfaction with this innovative educational modality. By examining a wide range of factors, including sociodemographic characteristics, academic factors, and environmental influences, this research offers valuable insights for educators to optimize blended learning experiences in nursing education. Methods: A descriptive cross-sectional research design was conducted. This study investigates the factors influencing nursing students' satisfaction with blended learning at Alexandria University, Egypt, where blended learning programs have been integrated into the curriculum primarily through the Microsoft Teams platform. A convenient sample of 1266 nursing students from both bachelor and technical educational institutions participated in the study from September 2023 to the end of December 2023. Data were collected using an online survey containing two measurement tools: the Blended Learning Satisfaction Scale and the Environmental Facilitators and Barriers to Student Persistence in Online Courses scale. Statistical analyses, including descriptive statistics and backward multiple linear regression, were conducted to identify factors that are associated with the satisfaction of nursing students' with blended learning. Results: Findings indicate that factors such as age, gender, income, employment status, access to suitable internet sources, academic year, computer literacy, preferred learning method, and perceptions of environmental facilitators significantly influence satisfaction scores (all p < 0.001). The overall regression model, with an adjusted R² of 0.31, signifies that 31% of the variance in satisfaction scores is explained collectively by the previously mentioned variables (F = 21.21, p < 0.001). Conclusion: Students' sociodemographic variables, preference for blended learning, and perception of environmental facilitators such as encouragement to enroll in the course significantly influence nursing students' satisfaction levels with blended learning. However, limitations in the current study such as self-report bias, convenient sampling, and cross-sectional design limit the generalizability and causal inferences of these findings. [ABSTRACT FROM AUTHOR]

Background: Despite widespread use of higher levels of care in treating eating disorders in adolescents, research supporting the use of these treatments remains limited by small sample sizes and a predominant focus on anorexia nervosa. Further, existing data regarding predictors of outcome have yielded mixed findings. In the current study, we evaluated treatment outcomes and predictors of outcome among a large sample of adolescents with eating disorders presenting to inpatient, residential, partial hospitalization programs, and intensive outpatient programs across the United States. Methods: Adolescents (N = 1,971) completed self-report measures of eating disorder symptoms, depression, and anxiety at treatment admission, stepdown, and discharge. Using linear mixed effect models, we evaluated changes in symptoms over treatment separately among youth admitted to inpatient/residential treatment and those admitted to partial hospitalization/intensive outpatient programs, and used established metrics to gauge frequency of reliable (i.e., statistically reliable) and clinically significant change. Results: Results suggested decreases in eating disorder symptoms, depression, and anxiety from intake to discharge. Around 50% of the sample reported reliable decreases in eating disorder symptoms at stepdown and discharge, with 30% of the sample reporting reliable reductions in depression and anxiety. Psychiatric comorbidity, primary diagnosis, age, and eating disorder symptoms at admission consistently predicted treatment-related change, although patterns in findings varied across symptoms. Conclusions: Data from our sample are consistent with past work suggesting that adolescents enrolled in higher levels of care report clinical benefit; however, these effects are heterogenous, and a significant portion of individuals may not report reliable change in symptoms. Ultimately, ongoing work is required to better understand how and for whom higher levels of care may achieve their benefit and to identify the optimal approach for improving outcomes for adolescents with eating disorders. [ABSTRACT FROM AUTHOR]

Background: This study explored the relationship between attention, negative emotions, empathy, mindfulness, and psychological trauma in catastrophic events to reduce psychological trauma in the public. Methods: A total of 526 adults in Guangxi Province, China, were investigated using self-rating scales for post-traumatic stress disorder, emotion, and empathy, as well as a five-factor self-rating mindfulness scale and a catastrophic incident concern questionnaire. Results: The results revealed the following: (1) Emotion significantly mediated attention and psychological trauma. (2) Empathy had a significant mediating effect on attention and psychological trauma. (3) Mindfulness moderated the relationship between negative emotions and psychological trauma, amplifying the impact of emotions on trauma rather than buffering it. Conclusions: When people pay attention to catastrophic events, they should remain sensible and restrained, and avoid excessive emotional involvement to reduce the excessive psychological trauma caused by the event. [ABSTRACT FROM AUTHOR]

Background: Aging results in changes in resting state functional connectivity within key networks associated with cognition. Cardiovascular function, physical activity, sleep, and body composition may influence these age-related changes in the brain. Better understanding these associations may help clarify mechanisms related to brain aging and guide interventional strategies to reduce these changes. Methods: In a large (n = 398) sample of healthy community dwelling older adults that were part of a larger interventional trial, we conducted cross sectional analyses of baseline data to examine the relationships between several modifiable behaviors and resting state functional connectivity within networks associated with cognition and emotional regulation. Additionally, maximal aerobic capacity, physical activity, quality of sleep, and body composition were assessed. Associations were explored both through correlation and best vs. worst group comparisons. Results: Greater cardiovascular fitness, but not larger quantity of daily physical activity, was associated with greater functional connectivity within the Default Mode (p = 0.008 r = 0.142) and Salience Networks (p = 0.005, r = 0.152). Better sleep (greater efficiency and fewer nighttime awakenings) was also associated with greater functional connectivity within multiple networks including the Default Mode, Executive Control, and Salience Networks. When the population was split into quartiles, the highest body fat group displayed higher functional connectivity in the Dorsal Attentional Network compared to the lowest body fat percentage (p = 0.011; 95% CI − 0.0172 to − 0.0023). Conclusion: These findings confirm and expand on previous work indicating that, in older adults, higher levels of cardiovascular fitness and better sleep quality, but not greater quantity of physical activity, total sleep time, or lower body fat percentage are associated with increased functional connectivity within key resting state networks. [ABSTRACT FROM AUTHOR]

The literature suggests that two distinct competencies [i.e., information technology ability (ITA), and internet self-efficacy] are necessary for the effective use of information technologies for successful ageing, but no study has examined the association of these skills on successful ageing and its domains (i.e., illness avoidance, functioning, and engagement with life). This study investigated whether Internet Self-Efficacy (ISE) moderates the potential association of ITA with successful ageing. The study adopted a cross-sectional design based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist and includes measures against confounding and common methods bias. The participants were 1186 older workers aged 50 years or older in three African countries (Kenya = 350; Nigeria = 260; Ghana = 576). The minimum sample size necessary was calculated, and data were analysed with hierarchical linear regression analysis. After controlling for the covariates, ITA and ISE had a positive association with successful ageing as well as illness avoidance, functioning, and engagement with life in the whole sample. ITA was also positively associated with successful ageing and its domains in Kenya and Ghana. The associations of ITA with successful ageing and its domains were positively moderated by ISE in the whole sample and within each of the three samples. Higher ITA can be associated with successful ageing among working older adults, and ITA positively influences successful ageing at different levels of ISE. Older adults with high ITA are more likely to avoid illness at a higher ISE. [ABSTRACT FROM AUTHOR]

This randomized clinical trial evaluated the effectiveness of short, digital interventions in improving physical activity and pain for individuals with knee osteoarthritis. We compared a digital mindset intervention, focusing on adaptive mindsets (e.g., osteoarthritis is manageable), to a digital education intervention and a no-intervention group. 408 participants with knee osteoarthritis completed the study online in the US. The mindset intervention significantly improved mindsets compared to both other groups (P < 0.001) and increased physical activity levels more than the no-intervention group (mean = 28.6 points, P = 0.001), but pain reduction was not significant. The mindset group also showed significantly greater improvements in the perceived need for surgery, self-imposed physical limitations, fear of movement, and self-efficacy than the no-intervention and education groups. This trial demonstrates the effectiveness of brief digital interventions in educating about osteoarthritis and further highlights the additional benefits of improving mindsets to transform patients' approach to disease management. The study was prospectively registered (ClinicalTrials.gov: NCT05698368, 2023-01-26). [ABSTRACT FROM AUTHOR]

Background: There is growing global concern about poor mental health among adolescents in sub-Saharan Africa. In particular, adolescent girls face multiple challenges in managing menstruation which can impact both their health and wellbeing. In this study we address an evidence gap on the association of a broad range of menstrual-related factors with mental health problems amongst secondary school female adolescents in Uganda. Methods: We used baseline data from a cluster-randomised menstrual health intervention trial conducted in 60 secondary schools in two districts in Uganda. Baseline data were collected between March and July 2022, including socio-demographic characteristics, menstrual knowledge and attitudes, menstrual practices and self-efficacy, and mental health problems measured using the Strengths and Difficulties Questionnaire Total Difficulties score (SDQ-25). We used random-effects linear regression to estimate the adjusted mean difference (aMD) for the association between mental health problems (SDQ Total Difficulties Score) and menstrual-related factors, including the Menstrual Practice Needs Scale (MPNS) and the Self-Efficacy in Addressing Menstrual Needs scale (SAMNS)), accounting for school-level clustering and adjusting for prior confounders. Results: Among the 3841 female participants, there was strong and consistent evidence of associations between mental health problems and menstrual-related factors. Mental health problems were associated with poor knowledge about menstruation (aMD = 1.17, 95%CI 0.50, 1.84 <0.001), using disposable and reusable menstrual products compared to using just disposable products (aMD = 1.42, 95%CI 0.92, 1.92, p <0.001), and experiencing menstrual pain even when using an effective management method at last menstrual period (LMP) compared to those experiencing no pain (aMD = 1.60, 95%CI 1.19, 2.01, p <0.001). Mental health problems were also associated with greater unmet menstrual needs according to the MPNS (aMD = 4.40 95%CI 3.96, 4.84, p <0.001), and with lower menstrual self-efficacy measured by the SAMNS (aMD = 0.94 95% CI 0.51, 1.37, p <0.001). Conclusion: This study shows strong evidence that mental health problems reported by adolescent girls in Uganda are associated with poor menstrual health. The association between menstrual health and mental health provides evidence as to why menstrual health should be a public health priority. Trial registration: Trial registration: ISRCTN 45461276. Registered on 16 September 2021. [ABSTRACT FROM AUTHOR]

Introduction: Rotator cuff tears (RCTs) are a common source of pain in the shoulder girdle. There is still debate about the optimal treatment for older adults with RCTs. In clinical practice, patients who do not respond well to non-surgical management may still be eligible for operative treatment. In this study, we assessed the outcome of arthroscopic repair of RCTs in patients ≥60 years old. Material and method: A retrospective case series was conducted to include patients who underwent arthroscopic repair of RCTs from 1 January 2018 to 1 January 2021. The study included individuals aged ≥60 years who had radiologically confirmed RCTs (verified by MRI) and clinical findings including sleep-disturbing pain and reduced range of motion. Preoperative treatment included physiotherapy for at least 6 months and one subacromial corticosteroid injection. Results: Fifty-three RCTs were treated during the study period. After exclusion because of incomplete documentation, 45 patients remained. The mean age was 66 years and 80% had isolated supraspinatus tears and 25% had variable degrees of fatty infiltration (Goutallier grade 1-3) on MRI examination with positive tangent sign. There were no surgical site infections and three symptomatic re-ruptures (6%). At follow-up, (71%) reported no remaining sleep-disturbing shoulder pain. Abduction improved from 62° to 122°. Flexion improved from 68° to 135°. This study found that people aged 60 years and older who underwent repair of RCTs showed statistically significant clinical improvement in shoulder flexion and abduction with less sleep-disturbing shoulder pain. These encouraging results may contribute to the existing literature, favoring the choice of surgical treatment for symptomatic RCTs in this age group with failed nonoperative treatment. Conclusion: The arthroscopic repair of RCTs in patients 60 years and older yielded a substantial increase in shoulder flexion and abduction, significantly reducing sleep-disturbing shoulder pain. Postoperative complications were minimal. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the relationship between physical exercise and depression among college students, focusing on themediating role of self-esteem and positive psychological capital. Methods: Group psychologicalmeasurements were conducted on 579 students using various scales, including the Physical Activity Rating Scale (PARS-3), Self-Esteem Scale (SES), Positive Psychological Capital Questionnaire (PPQ), and Self-rating Depression Scale (SDS). The data was analyzed using SPSS 26.0 and bootstrap methods to test and analyze the effects. Results: A negative correlation between physical exercise and depressive mood, with physical exercise significantly predicting college students' depressive mood. Additionally, physical exercise was found to positively predict self-esteem and positive psychological capital, both of which are negatively predictive of depressive mood. Self-esteem and positive psychological capital were identified as significant mediators between physical exercise and depressive mood, with threemediating paths: physical exercise, self-esteem, and depressedmood (Path 1), exhibited an indirect effect of 0.017, with the bootstrap 95% confidence interval excluding 0 (LLCI = -0.051, ULCI = -0.004) and accounting for 8.30% of the total effect. Physical exercise, positive psychological capital, and depression emotion (Path 2), had an indirect effect of 0.049, with the bootstrap 95% confidence interval also not containing 0 (LLCI = -0.088, ULCI = -0.011) and contributing to 23.90% of the total effect. Physical exercise, self-esteem, positive psychological capital, depressed mood (Path 3), demonstrated an indirect effect of 0.006, with the bootstrap 95% confidence interval excluding 0 (LLCI = -0.011, ULCI = -0.001) and representing 2.90% of the total effect. Conclusion: Physical exercise negatively predicts depressive mood among college students and has a mediating effect through self-esteem and positive psychological capital, creating a chain-like impact on their depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: Bruxism is a recurrent parafunctional habit characterized by clenching or grinding teeth and/or jaw contractions. It is quite common among dental students and is associated with psychosocial factors such as stress and anxiety. This study aimed to compare bruxism awareness and self-assessment among clinical students with and without bruxism. Methods: This study included systemically healthy individuals aged 18 to 27 years. Intraoral and extraoral examinations were performed on 128 4th- and 5th-grade dental students with (64) and without bruxism (64), 4th and 5th-grade dental students at Bolu Abant İzzet Baysal University who met the inclusion criteria. The diagnosis of bruxism was based on the 2018 International Consensus and data collected through a validated 33-item questionnaire covering general information and bruxism awareness. The questionnaire included multiple-choice questions on bruxism types, risk factors, symptoms, and impact on periodontal tissues. Statistical analyses were performed via IBM SPSS Statistics, and p < 0.05 was considered statistically significant. Results: Clenching and teeth grinding during sleep, tooth wear, muscle fatigue, pain in the temples, jaw pain, joint trismus, neck pain, and jaw joint pain and clenching while awake were significantly different in bruxism patients (p < 0.05). There was no significant difference between the two groups in terms of bruxism type, symptoms, treatment methods, periodontal tissues, occlusal trauma, diagnostic methods, or the relationship between lifestyle and bruxism (p > 0.05). While 71.9% of those diagnosed with bruxism stated that they had bruxism, 68.8% of those who were not diagnosed stated that they did not have bruxism. Conclusion: Although dental students are aware of bruxism, their understanding of its multifactorial nature and treatment options needs improvement. Increasing this knowledge could reduce the prevalence of bruxism among dental students and improve patient care. Clinical trial registration: The clinical trial was retrospectively registered on ClinicalTrials.gov under the identifier NCT06583044, with a registration date of 03/09/2024. https://register.clinicaltrials.gov/prs/beta/studies/S000EUYA00000023/recordSummary. [ABSTRACT FROM AUTHOR]

Background: Migraine is a prevalent neurologic disorder that affects women more than men. Examining health-related quality of life (HRQoL) by gender can aid decision makers in prioritizing future treatment and prevention programs. We aimed to quantify HRQoL by different levels of migraine disability and by gender. Methods: As part of a Canada-wide cross-sectional study, we administered an online survey to employed adults who self-reported a diagnosis of migraine. Migraine disability level was assessed using the Migraine Disability Assessment questionnaire (MIDAS). MIDAS scores were used to categorize respondents as having little to no, mild, moderate, or severe level of migraine-related disability. Physical and mental component summary scores (PCS and MCS) and health utilities were derived from responses to the Veterans Rand 12 Item Health Survey. PCS, MCS, and health utilities were summarized by migraine-related disability levels and gender. Covariate-adjusted linear regressions were used to examine the association between migraine disability level and health utility by gender. Results: A total of 441 participants completed the survey. The sample was predominantly women (60.1%), White race (75.5%), and had a mean age of 37 years. Mean health utility, PCS, and MCS scores were 0.61 (0.22), 45.0 (7.7), and 43.4 (11.0), respectively. All three scores decreased with increased migraine disability level. Gender differences on HRQoL within each migraine disability level were not statistically significant, except in the little to no disability level where women had lower mean MCS scores and health utility relative to men [mean (SD) MCS: women 44.0 (11.3); men 55.1 (8.1), p < 0.001; health utility: women 0.66 (0.18); men 0.81 (0.18), p < 0.001]. Linear regressions showed women with severe migraine-related disability had reduced health utility compared to women with little to no disability [adjusted difference: -0.16 (95%CI -0.24,-0.09)]. Associations among men increased in magnitude with migraine disability level [adjusted differences: mild − 0.16 (95%CI -0.24,-0.09); moderate − 0.18 (95%CI -0.26,-0.10); severe − 0.28 (95%CI -0.37,-0.20)]. Conclusions: Findings contribute to the literature on the association between migraine disability level and HRQoL by examining trends by gender. Model results emphasize the importance of future treatments reducing severe disability due to migraine among both women and men. [ABSTRACT FROM AUTHOR]

Cognitive offloading refers to using an external medium such as paper to remember information rather than relying solely on memory. Previous research has suggested that individuals' perceived memory performance may influence their decision to employ cognitive offloading as a learning strategy. However, ubiquitous distortions in metacognitive judgments limit the learning gains. Motivated by this, the current study incorporated second-order metacognitive judgments (SOJs) with distorted first-order metacognitive judgments (FOJs) within a learning context that allowed cognitive offloading. We investigated how individuals decide to employ cognitive offloading based on two levels of self-assessments. Eighty participants from the U.S. were recruited remotely to complete online paired-associate tasks. They learned 48 paired associates on an item-by-item basis, providing a FOJ, an SOJ, and a strategy (offload or not) on each trial. Our findings showed a significant effect of interaction between FOJs and SOJs on the selection of cognitive offloading. Additionally, there were significant variabilities in employing cognitive offloading across individual participants and word pairs. We concluded that SOJs influence the association between FOJs and strategy choices. Furthermore, we attributed the observed interaction to the assessment and regulation of SOJ about FOJ. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this proof-of-concept multimethod exploratory single case study is to increase knowledge of the underlying mechanisms of alliance ruptures and repairs in Borderline Personality Disorder treatment across and within the psychotherapeutic treatment process. Method: The multimethod includes outcome assessment of patient self reporting questionnaires (the Affect Integration Inventory, the Hopkins Symptom Checklist), observation-based ratings of sessions with the Rupture Resolution Rating System, quantitative analysis of heart rate variability using recurrence quantification analysis, and a qualitative multimodal interaction analysis of within-session dynamics. Result: Results reveal how patterns of heart rate synchrony between patient and therapist reflect periodical patterns of emotional interaction corresponding to key therapeutic alliance processes throughout the treatment process. Particularly, heart rate synchronization and desynchronization correspond with increasing rupture resolution ratings and positive outcome measures in the last part of the therapy process, indicating increased productivity, affectivity, and positive change. The qualitative microanalysis highlights context sensitivity to alliance management within sessions. Physiological arousal is found to underlie important alliance processes, including emotion regulation, relatedness, security, empathic responding, sense-making, and validation in correspondence with different therapist verbal and non-verbal markerbs. Discussion: Clinical implications and study limitations are discussed. Recommendations are made for future directions in relation to applying multimethod approaches when studying rupture and repair processes in psychotherapy. [ABSTRACT FROM AUTHOR]

Purpose: Investigations of the quality of life (QoL) of young people have shown that psychological and behavioral problems are associated with lower subjective well-being. The QoL ratings of children and adolescents based on self-reports and proxy reports are significantly different. The aim of the present study was to examine youth self-reported and parent proxy-reported QoL and investigate the effects of age, gender and psychological/behavioral symptoms on the QoL reports of youth. We hypothesized that self-reported emotional and anxiety problems influence self-reported QoL, while proxy-reported behavioral problems influence proxy reports of QoL. Methods: The sample consisted of 284 parent–child pairs. Youths were between the ages of 11 and 18 years, the mean age was 14.3 (SD 2.1) years, and 35.6% were males. The Inventory of Life Quality (ILK) scale was used to measure QoL, and the Strengths and Difficulties Questionnaire was used to assess psychological and behavioral problems. Results: Males had higher self-reported QoL than females, and younger children had better QoL than older children. Emotional peer problems and hyperactivity reported by youth and hyperactivity and conduct problems reported by parents predicted youth self-rated ILK. Only parent-reported psychological/behavioral problems predicted proxy-rated ILK. Conclusion: The evaluation of QoL of children and adolescents should involve both self and proxy reports in order to capture the effects of various psychological/behavioral symptoms and the perspectives of both youth and parents. [ABSTRACT FROM AUTHOR]

Background: As a result of the COVID-19 pandemic, we implemented a novel nurse-led symptom monitoring and virtual telehealth program for patients with advanced cancer on palliative care. Aims: To evaluate the reach, effectiveness, adoption, implementation, maintenance and acceptability of our program. Methods: This was a prospective study carried out in a cohort of patients with advanced cancer over the period of 3rd June 2020 to 22nd October 2021. Demographic characteristics, cancer diagnosis, and functional status of patients were collected upon recruitment. Patients were asked to complete a patient-reported outcome measure (the Integrated Palliative Care Outcome Scale, IPOS) prior to the first palliative care consult and subsequently every week for the duration of their participation in the program (12 weeks). The IPOS measures the severity of physical symptoms, emotional concerns, information, and financial needs. Participants' utilization of healthcare services by participants 3 months before, during and 3 months after the telemedicine program was reviewed. At the end of the program, a client satisfaction questionnaire (CSQ-4) to survey participants' experience with the telehealth program and their willingness to pay for this program was administered. Results: Reach: The recruitment to adoption ratio of the program was 0.71. Acceptability:: Participants expressed satisfactory experience. Effectiveness: We noted that the severity of patients' symptoms and number of emergency department visits decreased over time with nurse support. Adoption: we received referrals from 23 oncologists, yielding an adoption rate of 70%. Implementation: Of the 99 patients recruited for the program, 88.9% of them managed to complete their initial video consults as planned. 16% of them failed to complete the program due to factors such as patient demising. Maintenance: The declining rate of IPOS completion throughout the study period (98.9% at week 1 to 60.8% at week 12) demonstrated the difficulties in sustaining regular administration of self-reported patient outcome measures. Conclusion: The telemedicine program was effective and acceptable. We noted challenges in sustaining the administration of patient reported outcome measures over time. Further studies on how we can improve the sustainability of symptom monitoring in a telehealth program for patients with advanced illnesses, under palliative care, should be conducted. [ABSTRACT FROM AUTHOR]

Background: Colombia, which hosts over 3 million of the Venezuelan diaspora, is lauded for its progressive approach to social integration, including providing migrants access to its universal health coverage system. However, barriers to healthcare persist for both migrant and host populations, with poorly understood disparities in healthcare-seeking behaviors and associated costs. This is the first study to link healthcare-seeking behaviors with costs for Venezuelan migrants in Colombia, encompassing costs of missing work or usual activities due to healthcare events. Methods: We use self-reported survey data from Venezuelan migrants and Colombians living in Colombia (September-November 2020) to compare healthcare-seeking behaviors and cost variables by nationality using two-sampled t-tests or Chi-square tests (X2). The International Classification of Diseases was used to compare reported household illnesses for both populations. Average health service direct costs were estimated using the Colombian Government's Suficiencia database and self-reported out-of-pocket (OOP) payments for laboratory and pharmacy services. Indirect costs were calculated by multiplying self-reported days of missed work or usual activities with estimated income levels, derived by matching characteristics using the Gran Enquesta Integrada de Hogares database. We calculate economic burdens for both populations, combining self-reported healthcare-seeking behaviors and estimated healthcare service unit costs across six healthcare-seeking behavior categories. Results: Despite similar disease profiles, Venezuelan migrants are 21.3% more likely to forego formal care than Colombians, with 746.3% more Venezuelans reporting lack of health insurance as their primary reason. Venezuelan women and uninsured report the greatest difficulties in accessing health services, with accessing medications becoming more difficult for Venezuelan women during the COVID-19 pandemic. Colombians cost the health system more per treated illness event (US$40) than Venezuelans (US$26) in our sample, over a thirty-day period. Venezuelans incur higher costs for emergency department visits (123.5% more) and laboratory/ pharmacy OOP payments (24.7% more). Conclusions: While Colombians and Venezuelans share similar disease burdens, significant differences exist in access, cost, and health-seeking behaviors. Increasing Venezuelan health insurance enrollment and tackling accessibility barriers are crucial for ensuring healthcare equity and effectively integrating the migrant population. Findings suggest that improving migrant access to primary healthcare would produce savings in Colombian healthcare expenditures. [ABSTRACT FROM AUTHOR]

Despite the growing acknowledgment of the importance of loneliness among older individuals, questionnaire length constraints may hinder the inclusion of common multi-item loneliness scales in surveys. Direct, single-item loneliness measures are a practical alternative, but scholars have expressed concerns that such measures may lead to underreporting. Our aim was to test whether such reservations are justified. We conducted a preregistered list experiment among 2,553 people aged 50 + who participated in the Dutch Longitudinal Internet studies for the Social Sciences (LISS) panel. The list experiment method has been developed to unobtrusively gather sensitive information. We compared the list experiment estimate of the prevalence of frequent loneliness with the corresponding direct question estimate to assess downward bias in the latter. Next to pooled models, we estimated models stratified by gender to assess whether loneliness underreporting differed between women and men. Relying on the direct question, we estimated that 5.9% of respondents frequently felt lonely. Our list experiment indicated that the prevalence of frequent loneliness was 13.1%. Although substantial in magnitude, the difference between both estimates was only marginally significant (Δb: 0.072, 95% CI: − 0.003;0.148, p =.06). No evidence of gender differences was found. Although we cannot be conclusive that loneliness estimates are biased downward when a direct question is used, our results call for caution with direct, single-item measures of loneliness if researchers want to avoid underreporting. Replications are needed to gain more precise insights into the extent to which direct, single-item loneliness measures are prone to downward reporting bias. [ABSTRACT FROM AUTHOR]

Background: This study aims to investigate the short-term effects and safety of adjunct Suxiao Jiuxin Pills (SJPs) on conventional therapy in chronic coronary syndrome (CCS) patients who are intolerant to the adverse effects of long-acting nitrates. Methods: This was a multicenter, randomized, double-blind, placebo-controlled trial. A total of 174 CCS participants from eight clinical study centers in China were included in the modified intention-to-treat analyses. Participants with CCS and intolerance to the adverse effects of long-acting nitrates were recruited and randomized to either the SJPs or the placebo group for a duration of 4 weeks. Results: Compared to the placebo group, the SJPs group showed a significant improvement in the efficacy rate after 4 weeks (OR = 2.43, 95% CI = 1.32 to 4.47, P = 0.004). Besides, individuals without a history of alcohol consumption showed a greater improvement in the SAQ summary score compared to those with a history of alcohol consumption. Conclusion: Adjunctive SJPs enhance the effectiveness of short-term conventional anti-angina treatment for patients with CCS who experience intolerance to long-acting nitrates, without significant adverse effects during application. Trial registration: Chinese Clinical Trials Registry Platform, ChiCTR2100050066. Registered 16 August 2021, https://www.chictr.org.cn/showproj.html?proj=131470. [ABSTRACT FROM AUTHOR]

Background: Plaque biofilm is a major etiologic factor of periodontitis, and its effective removal prevents or ameliorates the disease. However, toothbrushing alone does not sufficiently clean the interdental area, and additional interdental cleaning is required to completely remove the plaque from this locale. This cross-sectional study aimed to assess the association of interdental cleaning on the prevalence of periodontitis in a large urban Thai adult cohort. Methods: Interdental cleaning data were retrieved from a dental survey of 1,743 employees of the Electricity Generating Authority of Thailand (EGAT) in 2019. The Centers for Disease Control and Prevention/American Association of Periodontology (CDC/AAP) periodontal case definitions were applied. The participants were subdivided into two groups as those with or without periodontitis depending on their oral health status assessed by calibrated professional examiners. The proportion of subjects who performed interdental cleaning was assessed through a self-reported questionnaire by frequency (daily/ ≥ 1 per week/ none) and profile (correct/ incorrect) of interdental cleaning. Then, the association between interdental cleaning and periodontitis was calculated using logistic regression analysis controlling for the common risk factors of periodontitis such as age, sex, education, smoking, and diabetes. Results: Participants who performed interdental cleaning on a daily basis and ≥ 1 per week were 27.5% (95% CI: 25.4, 29.6) and 29.1% (95% CI: 27.0, 31.3), respectively while the remainder did not practice. Of those who used interdental cleaning, about one-half focused on sites with food impaction. There was a significant 44% lower prevalence of periodontitis (adjusted odds ratio of 0.56 (95%CI: 0.40, 0.79) in the cohort with a frequent and correct group. Conclusions: Our data indicate an inverse association between interdental cleaning and periodontitis, particularly in those who routinely adhered to it. Regular interdental cleaning is likely to have a salutary effect on oral health. Trial registration: The study was registered retrospectively in Thai Clinical Trials Registry, Registration number: TCTR20240817005, on 17 Aug 2024 (https://www.thaiclinicaltrials.org). [ABSTRACT FROM AUTHOR]

Importance: Since 2001, 3.5 million United States service members deployed overseas in support of the post-9/11 Global War on Terror. While healthy and fit upon deployment, veterans have experienced many complex and often unexplainable illnesses and chronic diseases, with more than 520 000 being diagnosed with cancer. With the implementation of the VA MISSION and PACT Acts, post-911 veterans are increasingly being seen in non-VHA healthcare facilities by non-physician providers. Objective: To assess the readiness of registered and advanced practice nurses to provide knowledgeable and competent healthcare for post-9/11 veterans in the civilian healthcare system. Design, setting and participants: A web-based survey was administered by the HunterSeven Foundation (a Veteran-founded non-profit organisation), with 541 nurse respondents. Primary outcomes and measures: Questions were designed to assess military knowledge, comfort level caring for veterans, self-reported proficiency and prior training of participants. Mean differences were compared using a restricted maximum likelihood, fixed-effects model, with incidence between groups estimated as log-binomial relative risks. Results: Meaningful gaps in clinical knowledge of screening for and treatment of medically related conditions were identified. Our assessment also highlighted a sparseness of knowledge for making care recommendations based on apposite resources. Conclusions and relevance: Cognitive biases among healthcare providers in the civilian sector may lead to missed and/or delayed diagnoses, therefore emphasising the need for additional training focused on caring for post-9/11 veterans. [ABSTRACT FROM AUTHOR]

Assessment of sport-related concussion (SRC) has begun to include patient-reported outcome measures. However, understanding of which health limitations are most meaningful to adolescents after SRC is limited. To explore patient-perceived activity limitations after SRC and throughout recovery to return to play and mapped according to the International Classification of Functioning, Disability, and Health (ICF) model. Longitudinal study. Secondary school athletic training facilities. Fifty patients (41 males, 5 females, 4 sex not reported, age = 14.9 ± 3.5 years, grade = 10.2 ± 0.93 level) with a medically diagnosed SRC. The Patient Specific-Functional Scale (PSFS) was used to assess changes in the patient's condition and the effect the injury posed on their ability to perform activities. The PSFS is a self-reported assessment of health used to identify activity limitations and rate the difficulty of performing those tasks. The PSFS was administered to patients on days 3 (D3) and 10 (D10) after SRC and at return to play. Activities affected by injury were coded into common categories and themes by a 3-person research team for subsequent analysis. The coded themes were also mapped to the ICF domains, chapters, and categories. The dependent variables were the PSFS themes, number of activities endorsed, PSFS scores, ICF domains, chapters, and categories. Descriptive analyses and frequencies were reported for the dependent variables. A total of 157 different activities were identified at D3 and coded into 28 categories that fit into 6 themes: activities of daily living, cognitive and school (COG), sports and physical activity (SPA), screen time, sleep, and social. On D3, all patients (50/50) identified at least 1 activity limitation. Most related to SPA (37.6%) and COG (31.2%). Sixty percent of patients endorsed activity limitations at D10, primarily in COG (38.6%) and SPA (36.6%). All (100%) response categories were mapped to the ICF, with most (75%) fitting the activities and participation domain. Our primary findings suggest that SRC influences many facets of the lives of adolescent athletes. Specifically, adolescent athletes identified activity restrictions primarily related to physical activity and sports participation. [ABSTRACT FROM AUTHOR]

Despite the availability of specialized assessment tools, psychological readiness is usually not considered when deciding to return to sport (RTS) after sport injury. Reinjury anxiety, self-confidence, and functional attention may be associated with sport reinjury, making it important to evaluate these factors before RTS. To predict lower extremity reinjury in soccer players using self-confidence, functional attention, and reinjury anxiety as predictive variables. Prospective cohort study. Laboratory. Sixty-two male soccer players, who were older than 18 years of age, suffered from lower extremity injuries, had completed the rehabilitation program, and were ready to RTS. Before returning to the sport, participants completed a preseason questionnaire on their previous injuries, self-confidence, reinjury anxiety, and level of functional attention. The primary outcome measured was the risk of reinjury during the upcoming competitive season, and logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) to determine the association between each risk factor and reinjury. The overall reinjury rate was 5.56 injuries per 1000 hours of play. Self-confidence scores of ≤47 increased the risk of reinjury by 2.26 times (relative risk = 2.26; 95% CI, 1.31–3.91; OR = 5.00; 95% CI, 1.56–16.04), and each unit increase in self-confidence score reduced the risk of reinjury by 10% (OR = 0.90; CI, 0.82–0.99; P =.03). Regarding reinjury anxiety, a score of >22 was associated with 2.43 times the risk of reinjury (relative risk = 2.43; 95% CI, 1.44–4.13; OR = 6.46; 95% CI, 1.93–21.69), and each unit increase in reinjury anxiety score increased the risk of injury by 45% (OR = 1.45; CI, 1.13–0.87; P =.004). Increased reinjury anxiety and decreased self-confidence are associated with higher odds of lower extremity reinjury in male soccer players. To reduce the risk of reinjury, athletic trainers and sport psychologists should take these psychological factors into account when evaluating the psychological readiness of soccer players with a history of lower extremity injury to RTS. [ABSTRACT FROM AUTHOR]

Before examining the impact of training load on injury risk in runners, it is important to gain insight into the differences between methods that are used to measure change in training load. To investigate differences between 4 methods when calculating change in training load: (1) weekly training load; (2) acute : chronic workload ratio (ACWR), coupled rolling average (RA); (3) ACWR, uncoupled RA; (4) ACWR, exponentially weighted moving average (EWMA). Descriptive epidemiology study. This study is part of a randomized controlled trial on running injury prevention among recreational runners. Runners received a baseline questionnaire and a request to share global positioning system training data. Runners who registered for running events (distances 10–42.195 km) in the Netherlands. The primary outcome measure was the predefined significant increase in training load (weekly training loads ≥ 30% progression and ACWRs ≥ 1.5), based on training distance. Proportional Venn diagrams visualized the differences between the methods. A total of 430 participants (73.3% men; mean age = 44.3 ± 12.2 years) shared their global positioning system training data for a total of 22 839 training sessions. For the weekly training load, coupled RA, uncoupled RA, and EWMA method, respectively, 33.4% (95% CI = 32.8, 34.0), 16.2% (95% CI = 15.7, 16.6), 25.8% (95% CI = 25.3, 26.4), and 18.9% (95% CI = 18.4, 19.4) of the training sessions were classified as significant increases in training load. Of the training sessions with significant increases in training load, 43.0% from the weekly training load method were different than the coupled RA and EWMA methods. Training sessions with significant increases in training load based on the coupled RA method showed 100% overlap with the uncoupled RA and EWMA methods. The difference in the change in training load measured by weekly training load and ACWR methods was high. To validate an appropriate measure of change in training load in runners, future research on the association between training loads and running-related injury risk is needed. [ABSTRACT FROM AUTHOR]

A large-scale (n = 1323) survey of mnemonic recall, self-reported familiarity, cued explanation, and application by introductory statistics students was conducted at a large research university in the southeastern United States. The students were presented 14 mnemonics during the fall 2017 term. Different nonoverlapping cohorts of students were asked at different time points to complete a survey about mnemonic use. At each time point, the students were asked to recall any mnemonic that they remembered, explain the mnemonic when cued, self-report their degree of familiarity, and apply the mnemonic. Of the 14 mnemonics, acronym-type mnemonics were recalled more frequently, but longer phrase-type mnemonics were explained and applied more often. These findings suggest that instructors should provide scaffolding to move a student from recalling a mnemonic to using a mnemonic toward successful completion of the statistics problem at hand. [ABSTRACT FROM AUTHOR]

Background The proportion of women surgeons is increasing, but studies show that women in surgical residency are granted less autonomy than men. Objective We utilized the Surgical Autonomy Program (SAP), an educational framework, to evaluate gender differences in self-reported autonomy, attending-reported autonomy, and operative feedback among US neurosurgical residents. Methods The SAP tracks resident progression and guides teaching in neurosurgery. Surgeries are divided into zones of proximal development (opening, exposure, critical portion, and closure). Postoperatively, resident autonomy is rated on a 4-point scale by the resident and the attending for each part of the case, or zone. We utilized data from July 2017 to February 2024 from 8 institutions. Ordinal regression was used to evaluate the odds of self- and attending-evaluated autonomy, accounting for gender, training year, case difficulty, and institution. Differences between attending assessment and self-assessment were calculated across time. Chi-square analyses were used to measure any differences in feedback given to men and women. Results From 128 residents (32 women, 25%), 11894 cases were included. Women were granted less autonomy (OR 0.81; 95% CI 0.74-0.89; P<.001) and self-evaluated as having less autonomy (OR 0.73; 95% CI 0.67-0.80; P<.001). The odds of women operating at higher autonomy were similar to the odds of operating on a hard case compared to average difficulty (OR 0.77; 95% CI 0.71-0.84; P<.001). Men's and women's self-assessment became closer to attending assessment over time, with women improving more quickly for the critical portions of surgeries. Women residents received meaningful postoperative feedback on fewer cases (women: 74.2%, men: 80.5%; X2=31.929; P<.001). Conclusions Women operated with lower autonomy by both attending and self-assessment, but the assessment gap between genders decreased over time. Women also received less feedback from their attendings. [ABSTRACT FROM AUTHOR]

Simple Summary: Research continues to show that exercising at recommended levels is associated with lower mortality rates and decreased risk of recurrence in breast cancer survivors (BCS). Moreover, those BCS exercising at levels meeting guidelines have higher self-reported health-related quality of life (HR-QOL) than those that do not. This includes lowered levels of perceived global stress. However, which modalities of exercise are most effective has yet to be determined. Our study investigates changes in stress experienced by breast cancer survivors participating in one of three different exercise modalities conducted over six months, as indicated by self-report and salivary cortisol measures. The revealed improvement in constructs of Health Related-Quality of Life (HR-QOL) suggest that engagement in exercise had a greater impact on outcomes than any particular modality. Background/Objectives: Extensive evidence suggests that exercise is physically and mentally beneficial for cancer survivors. This study reports on changes in self-reported stress, physiological biomarkers for stress (salivary cortisol), and HR-QOL constructs for fifty breast cancer survivors participating in one of three different exercise programs over 6 months. Methods: Fifty post-treatment breast cancer survivors were randomized to either therapeutic yoga-based exercise (YE), comprehensive exercise (CE) (aerobic, resistance, flexibility), or choosing (C) their own exercise activities. Participants completed the Perceived Stress Scale (PSS), Medical Outcomes Short-Form 36® (SF-36), and the Pittsburgh Sleep Quality Index (PSQI). Five samples of salivary cortisol were collected on two consecutive days. The 10 samples were used to calculate the diurnal rhythm slope. Outcome measures were repeated after six months. Results: All groups improved in HR-QOL measures of PSS; PSQI sleep quality components of latency and daytime functioning; and five of the ten SF-36 scales (Mental Component Scale, Social Functioning subscale, Mental Health subscale, Physical Component Scale, Physical Functioning subscale). Although the CE group observed the most favorable change in cortisol (−0.183), where cortisol slope changes approached significance (p = 0.057), but no significant decrease in cortisol between groups were noted. Conclusions: Our results suggest that it is the engagement of, rather than the specific type of exercise, which is associated with improved HR-QOL. However, longer-term studies with better adherence monitoring and larger sample sizes are needed to better determine clinical impact. [ABSTRACT FROM AUTHOR]

We examined the sensitivity and time‐course of recovery of neuromuscular and perceptual player monitoring measures to U‐18 English Premier League academy football match play. Eighteen players performed maximal posterior chain, hip adductor and abductor isometric strength tests, countermovement jumps (CMJ) and provided self‐report wellbeing scores around eight competitive league home games: 1 day before (MD‐1), pre‐match (MD‐PRE), post‐match (MD‐POST) and two (MD+2) and three (MD+3) days post‐match. A permutational multivariate analysis of variance and post hoc univariate analyses of variance were used to examine match‐induced responses to monitoring variables. Between MD‐1 and MD‐POST, we observed small to moderate reductions to the adductor and abductor peak force and maximal impulse and IPCS peak force; small reductions to CMJ jump height (JH) (flight time), eccentric peak force and eccentric deceleration rate of force development and moderate to large reductions to perceived fatigue, muscle soreness and mood. No match‐induced changes were observed for CMJ flight time: contraction time or eccentric duration. Posterior chain, abductor, CMJ and self‐report measures normalised by MD+3 but adductor peak force remained compromised at MD+3 (ES = small). Posterior chain, adductor and abductor peak isometric force and maximal impulse; CMJ JH, eccentric peak force and eccentric deceleration rate of force development and perceived fatigue, muscle soreness and mood are sensitive to match‐induced fatigue. Since adductor peak force remained compromised at MD+3, it is apparent that players might not achieve complete neuromuscular recovery within 3 days of match play, and that the adductor muscle group might be particularly vulnerable to match‐induced fatigue. Highlights: U‐18 English Premier League (EPL) academy football match play induced acute reductions to countermovement jump (jump height [flight time], eccentric peak force and eccentric deceleration rate of force development); isometric strength (abductor, adductor and posterior chain peak force and abductor and adductor maximal impulse) and athlete self‐report (perceived fatigue, muscle soreness and mood) measures.Match‐induced changes to countermovement jump, abductor, posterior chain and self‐report measures typically normalised between MD+2 and MD+3 but adductor peak force remained compromised at MD+3.No meaningful match‐induced changes were observed to widely used countermovement jump movement strategy measures (i.e., flight time: contraction time ratio or eccentric duration).U‐18 EPL academy football players might not achieve complete neuromuscular recovery by MD+3. The adductor muscle group might be particularly susceptible to match‐induced fatigue. [ABSTRACT FROM AUTHOR]

Background: The use of appropriate personal protective equipment (PPE) in healthcare settings is a very important factor of infection control activities to prevent transmission of infection. In this study, we aimed to develop a non-face-to-face method that can reduce transmission of infection and an educational method that allows self-learning and self-training, and verify the effectiveness of a donning and doffing PPE education using video debriefing on third-year nursing students in clinical train. Methods: The researcher assigned groups through random sampling using a random number table from the list of research subjects who agreed to participate. Therefore, 35 subjects in the experimental group with an education on donning and doffing PPE using video debriefing and 34 subjects in the control group with video-based training (VBT) were participated in April 2023 at a university in Incheon, South Korea. The evaluation phase involved verifying effects of the education on observer evaluation donningand doffing PPE performance and self-evaluation donningand doffing PPE performance. Satisfaction with the education also assessed immediately after intervention by the experimental group. Results: The experimental group had significantly higher scores for observer evaluationdonning (t = 7.84, p <.001) and observer evaluation doffing (t = 6.52, p <.001) PPE performances than the control group. However, there was no significant difference in self-evaluation donning (t = 0.98, p <.330) or doffing PPE performance (t = 0.17, p <.869) between the two groups. In the experimental group that applied video debriefing, learning satisfaction was 4.33 ± 0.82 points out of 5 points. Conclusions: The education on donning and doffing PPE applying video debriefing was effective. If the education developed in this study is used as a self-learning method to improve the infection control capacity necessary to respond to a disaster crisis caused by infectious diseases, it is considered to be useful for preventing the transmission of infectious diseases in the future. [ABSTRACT FROM AUTHOR]

Background: Although older adults with heart failure (HF) and multiple chronic conditions (MCC) frequently rely on caregivers for health management, digital health systems, such as patient portals and mobile apps, are designed for individual patients and often exclude caregivers. There is a need to develop approaches that integrate caregivers into care. This study tested the feasibility of the Social Convoy Palliative Care intervention (Convoy-Pal), a 12-week digital self-management program that includes assessment tools and resources for clinical palliative care, designed for both patients and their caregivers. Methods: A randomized waitlist control feasibility trial involving patients over 65 years old with MCC who had been hospitalized two or more times for HF in the past 12 months and their caregivers. Descriptive statistics were used to evaluate recruitment, retention, missing data, self-reported social functioning, positive aspects of caregiving, and the acceptability of the intervention. Results: Of 126 potentially eligible patients, 11 were ineligible and 69 were deceased. Of the 46 eligible patients, 31 enrolled in the trial. Although 48 caregivers were identified, only 15 enrolled. The average age was 76.3 years for patients and 71.6 years for caregivers, with most participants being non-Hispanic White. Notably, 4% did not have access to a personal mobile device or computer. Retention rates were 79% for intervention patients, 57% for intervention caregivers, and 60% for control participants. Only 4.6% of survey subscales were missing, aided by robust technical support. Intervention patients reported improved social functioning (SF-36: 64.6 ± 25.8 to 73.2 ± 31.3) compared to controls (64.6 ± 27.1 to 67.5 ± 24.4). Intervention caregivers also reported increased positive perceptions of caregiving (29.5 ± 5.28 to 35.0 ± 5.35) versus control caregivers (29.4 ± 8.7 to 28.0 ± 4.4). Waitlist control participants who later joined the Convoy-Pal program showed similar improvements. The intervention was well-rated for acceptability, especially regarding the information provided (3.96 ±.57 out of 5). Conclusions: Recruiting informal caregivers proved challenging. Nonetheless, Convoy-Pal retained patients and collected meaningful self-reported outcomes, showing potential benefits for both patients and caregivers. Given the importance of a patient and caregiver approach in palliative care, further research is needed to design digital tools that cater to multiple simultaneous users. Trial registration: ClinicalTrials.gov Identifier NCT04779931. Date of registration: March 3, 2021. [ABSTRACT FROM AUTHOR]

Background: Headache disorders are among the most prevalent neurological disorders worldwide. However, whether groups differing in socioeconomic position (SEP) are disproportionately affected by headache disorders has not yet been adequately clarified. Our aim was to analyse (1) the headache prevalence by socioeconomic position (SEP) and (2) the attack frequency by SEP in a German population-based adult sample. Methods: Cross-sectional data from a random general population were used. The sample included N = 2,189 participants aged ≥ 18 years. SEP was measured using net equivalised income (NEI) and education. A binary logistic regression model tested the effect of SEP in predicting the prevalence of headache in general. Ordinal logistic regressions were modeled to predict the effect of SEP on the likelihood of attack frequency. Attack frequency was categorized in low frequency episodic headache (LFEH: 0–3 days per month), moderate frequency episodic headache (MFEH: 4–14 days per month) and chronic headache (CH: ≥ 15 days per month). Results: Of the 2,189 participants, 891 reported headache in the last six months. Neither income nor education was associated with headache prevalence. However, significant differences between income groups were found for attack frequency. Compared to participants with NEI > 150%, those with NEI < 60% were 5.21 times more likely (95%CI 2.03, 13.36) to experience higher headache frequency, and those with NEI between 60 and 150% were 2.29 times more likely (95%CI 1.02, 5.11), with adjustments made for a set of potential confounders, including depressive symptoms. Conclusions: To reduce headache attacks, it is essential to address both low- and middle-income groups affected by headaches. Universal public health prevention campaigns are particularly appropriate. [ABSTRACT FROM AUTHOR]

Background Antimicrobial resistance (AMR) is a significant global public health threat and key priority for the public health, especially health protection, workforce to lead by example. There is a paucity of learning resources on this for public health professionals (PHPs) in the UK. This project aimed to develop and disseminate a tailored interactive learning resource and evaluate impact on self-reported intention to change behaviour. Methods Learning objectives were agreed, content developed by the multi-disciplinary team and piloted by PHPs in 2022 alongside a matched pre- and post-implementation evaluation survey. Questions were mapped to the capability–opportunity–motivation–behaviour change model. Before and after responses were calculated to compare change in self-reported knowledge, understanding and behaviour. Significance of change in binary responses was estimated. Results The resource was delivered using an interactive, user-friendly and cost-free internal platform. Thirty-one PHPs completed the pilot e-learning and survey. Perceived and actual knowledge increased in parallel. Actual knowledge on AMR burden increased from 6.45 to 35.48% (P  = 0.004). Self-reported confidence to explain AMR to others improved by 0.71 (95% CI; 0.38–1.04: P  = 0.0001) Likert points on a five-point scale. Motivation to advocate for antimicrobial stewardship (AMS) in day-to-day work, improved by 0.71 (95% CI; 0.34–1.08: P  < 0.00001) Likert points. Case scenarios were well-received as an effective way to apply theory to practice. Conclusion Ensuring a well-informed and confident public health workforce is vital for reducing the AMR threat and advocating for AMS with the public and partner organizations. This targeted e-learning module is an effective additional learning medium in contributing to PHPs knowledge, understanding and self-reported intention to change behaviours. [ABSTRACT FROM AUTHOR]

Objective: Hoarding disorder is a complex condition that significantly impacts individuals' lives, characterized by excessive acquiring, difficulty discarding, clutter, distress, and impairment. This study aimed to examine the extent to which genetics and environment influence difficulty discarding, excessive acquisition, and clutter through the implementation of a classical twin study. Method: This classical twin study, conducted between April and September 2021, enrolled 194 twins (97 pairs) from Isfahan, recruited through the Isfahan Twins Registry (ITR). A total of 194 twins, consisting of 100 monozygotic (MZ) and 94 dizygotic (DZ) twins, participated in this study. Participants aged 16-50 were invited electronically and completed an online consent form and questionnaire. Hoarding symptoms were assessed using the saving inventory-revised. Zygosity was determined using a self-report method based on Song et al.'s questionnaire. To estimate the heritability of hoarding symptoms, the classical univariate twin model was employed. Results: Based on the univariate analysis, the heritability estimates for difficulty discarding and excessive acquisition were found to be 0.43 and 0.52, respectively. However, the results did not provide support for the role of genetics in clutter. Instead, it was indicated that the common environment accounted for 0.54 of the variance in clutter, while the specific environment contributed 0.46 to this symptom. Conclusion: The difficulty discarding and excessive acquisition were found to be moderately heritable. On the other hand, considering the contribution of genetics and environment to clutter, the results raise doubts about the association of clutter with hoarding. The relatively low genetic influence suggests that this trait may overlap with other behaviors rather than hoarding. [ABSTRACT FROM AUTHOR]

In response to COVID-19 social distancing restrictions, digitally delivered health interventions present as a potential solution for maintaining or improving individuals' physical activity. This study explored the feasibility of a web-based intervention, informed by the multi-process action control (M-PAC) framework to promote PA among individuals affected by social distancing. Fifty adults self-reporting as insufficiently active were randomized to a 6-week web-intervention (n = 27) or wait-list control (n = 23). Primary feasibility outcomes included recruitment and retention rates and usability and satisfaction scores; secondary outcomes of MVPA and M-PAC constructs and tertiary outcomes of mental health and wellbeing were also assessed. Overall, feasibility of the intervention was high, with a 96% recruitment rate, 84% retention rate, high satisfaction and usability scores, and comparable website usage to similar eHealth interventions. Intervention participants trended towards improved MVPA and M-PAC constructs and outcomes of mental health and wellbeing. Findings suggest study extension to a full-scale RCT. [ABSTRACT FROM AUTHOR]

Sedentary behavior (SB) has been linked to risk factors of cardiometabolic disease, with inconsistent findings reported in the literature. We aimed to assess the associations of SB with multiple biomarkers of inflammation and insulin resistance in adults. Domain-specific SB, sitting time and moderate-to-vigorous physical activity (MVPA) were measured in 78 adults (mean ± SD 52.0 ± 10.8 y). Body fat percentage (BF%) was assessed using multi-frequency bioelectrical impedance. A blood draw assessed glucose, insulin, C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), leptin, and adiponectin. Adiponectin-leptin ratio (ALR), homeostasis model assessment of insulin resistance (HOMA-IR) and beta-cell function (HOMA-β) were calculated. Multivariable linear regression analyses, controlling for age, sex, MVPA, and BF%, were used to assess associations. After adjustment for age, sex and MVPA, total SB (7.5 ± 2.5 h/day) was positively associated with leptin, insulin, HOMA-IR, HOMA-β (Standardized Beta (β) range 0.21–0.32) and negatively associated with ALR (β = -0.24, p < 0.05 for all). Similarly, total sitting time (7.2 ± 2.9 h/day) was associated with TNF-α (β = 0.22) and ALR (β = -0.26). These associations were attenuated to non-significance after adjustment for BF%. Leisure screen time was detrimentally associated with IL-6 (β = 0.24), leptin (β = 0.21), insulin (β = 0.37), HOMA-IR (β = 0.37), and HOMA-β (β = 0.34), independent of age, sex and MVPA (p < 0.05 for all). Only the associations with insulin (β = 0.26), HOMA-IR (β = 0.26), and HOMA-β (β = 0.23) remained significant after further controlling BF% (p < 0.05). Self-reported SB is associated with biomarkers of inflammation and insulin resistance, independent of MVPA, and in some cases BF%. [ABSTRACT FROM AUTHOR]

Purpose We aimed to document the acceptability (enrollment rate) and feasibility (phone call delivery rate) of implementing a behavioral PA intervention over 12 weeks, in addition to documenting its effects on patient-reported outcomes and physical functioning. This study also describes the costs of carrying out a behavioral PA intervention. A total of 40 participants were randomized in a 1:1 ratio. The tailored behavioral PA intervention was developed based on the most recent PA guidelines in pediatric oncology and on the COM-B framework to enact PA behavior changes. The prescription (frequency, intensity, time and type (FITT)) was adjusted each week during the weekly support calls. The control group did not receive the intervention. 26 males and 14 females (13.6 years old on average and 2.9 years post-cancer treatment on average) participated in our study. The acceptability rate was 90.9% and the feasibility rate was > 85%. We found that 85% improved PA frequency, 80% improved PA intensity, 100% improved PA time, and 50.0% achieved the recommended PA guidelines. No adverse events were reported over the duration of the intervention. Physical function improved with longer 6-minute walk distances in the intervention group (465.8 ± 74.5 m) than in the control group (398.7 ± 92.9 m) (p = 0.016). PROs scores for all participants were within the limits of the normal range. The estimated cost per participant of carrying out this intervention was USD $126.57. Our 12-week behavioral PA intervention, based on the COM-B framework, was found to be acceptable, feasible and safe in childhood cancer survivors. This study is an important step in the right direction to make exercise standard practice in pediatric oncology. Clinical trial registration: NCT04947709. [ABSTRACT FROM AUTHOR]

The purpose of this study was to: (1) compare the relative efficacy of different combinations of three behavioral intervention strategies (i.e., personalized reminders, financial incentives, and anchoring) for establishing physical activity habits using an mHealth app and (2) to examine the effects of these different combined interventions on intrinsic motivation for physical activity and daily walking habit strength. A four-arm randomized controlled trial was conducted in a sample of college students (N = 161) who had a self-reported personal wellness goal of increasing their physical activity. Receiving cue-contingent financial incentives (i.e., incentives conditional on performing physical activity within ± one hour of a prespecified physical activity cue) combined with anchoring resulted in the highest daily step counts and greatest odds of temporally consistent walking during both the four-week intervention and the full eight-week study period. Cue-contingent financial incentives were also more successful at increasing physical activity and maintaining these effects post-intervention than traditional non-cue-contingent incentives. There were no differences in intrinsic motivation or habit strength between study groups at any time point. Financial incentives, particularly cue-contingent incentives, can be effectively used to support the anchoring intervention strategy for establishing physical activity habits. Moreover, mHealth apps are a feasible method for delivering the combined intervention technique of financial incentives with anchoring. [ABSTRACT FROM AUTHOR]

Simple Summary: Avian influenza (AI) is an infectious disease and could lead to death, health problems, and economic losses. Therefore, this study aimed to gather information about the compliance with and perceived effectiveness of AI control measures (applicable during high-risk periods in Flanders, North of Belgium, in 2021) by professional laying hen farmers and private bird keepers. Overall, self-reported compliance was high among professional laying hen farmers but much less among private bird keepers. Among private bird keepers, compliance and perceived effectiveness were lowest for confining the birds indoors, whereas for farmers, it was lowest for placing nets over the free-range. This study highlights the need for information campaigns explaining to private bird keepers, particularly the need for the various AI control measures imposed. Should these campaigns prove unsuccessful, local authorities might need to implement stricter enforcement of existing control measures or explore alternative ways to increase compliance, such as information posters in relevant stores for private bird keepers or meeting private bird keeper interest groups to provide broader support. Competent authorities of many countries, including Belgium, impose control measures (preventing wild bird access to feeders and water facilities, indoor confinement of captive birds, or fencing off outdoor ranges with nets) on professional and non-professional keepers of birds to prevent the spread of avian influenza (AI). Flemish laying hen farmers (FAR, n = 33) and private keepers of captive birds (PRI, n = 263) were surveyed about their opinion on and compliance with AI measures legally imposed during the most recent high-risk period before this survey in 2021. Participants answered questions on a 5-point Likert scale (1 = the worst, 3 = neutral, and 5 = the best). FAR indicated better compliance with the AI measures than PRI, except for net confinement. FAR indicated that they and other poultry farmers complied better with AI measures than PRI. Additionally, PRI indicated that they better complied than other PRI keepers. FAR regarded the AI measures as more effective than PRI. To prevent the spread of AI more effectively, national authorities could focus on information campaigns explaining to private bird keepers the need for the various control measures that they impose. If these campaigns fail, local authorities may need stricter enforcement or alternative ways to increase compliance. [ABSTRACT FROM AUTHOR]