Search Results (3,045)

Self-leadership is increasingly important in service and knowledge-intensive work, yet sustained self-regulation may also create hidden psychological costs. This study introduces self-leadership overload (SLO) as a distinct self-regulatory strain state and examines whether it emerges nonlinearly, whether the self-leadership–SLO association is stronger under high work pressure, and whether SLO shows indirect associations with employee outcomes through work rumination. A two-wave survey of 408 full-time employees across seven service and knowledge-intensive sectors was analyzed using scale-development procedures, iterative PLS-SEM, two-stage nonlinear and moderation models, bootstrapped indirect-effect analysis, incremental-validity tests, and supplementary robustness checks. Self-leadership was positively associated with work happiness and sustainable performance, while its quadratic terms for these outcomes were nonsignificant. By contrast, the quadratic self-leadership–SLO term was positive and significant, indicating a progressively stronger association with overload at higher levels of self-leadership, and work pressure strengthened this association. SLO was associated with lower work happiness and sustainable performance and higher burnout and turnover intention; significant indirect associations through work rumination were observed for all four outcomes. SLO also explained additional variance beyond demographic and employment controls, conventional self-leadership, work pressure, and organizational and personal resources (ΔR² = 0.049–0.123). General organizational resources did not show the hypothesized buffering pattern, whereas health-oriented self-care was negatively associated with overload. The findings refine the self-leadership paradox by showing that a beneficial self-regulatory capability can coexist with an escalating internal burden without a corresponding direct curvilinear downturn in positive outcomes. The study contributes a theoretically bounded and empirically differentiated SLO construct and highlights workload boundaries, recovery, and health-oriented self-care as important conditions for sustainable self-leadership. Full article

Background/Objectives: The purpose of this study was to investigate the association between physical activity levels and life functioning among Korean older adults using data from the 2024 Korea National Health and Nutrition Examination Survey (KNHANES). Methods: Data from 1418 adults aged ≥65 years were analyzed in this cross-sectional study. Participants were classified into Aerobic-only, Muscle-strengthening-only, Combined, and Inactive groups according to whether their self-reported physical activity met the World Health Organization’s recommendations. Associations with life functioning were examined using complex sample logistic regression analyses adjusting for demographic, lifestyle, and health-related covariates. Results: Compared with the Inactive group, the Aerobic-only (odds ratio [OR] 1.55, 95% confidence interval [CI] 1.11–2.18), Muscle-strengthening-only (OR 1.65, 95% CI 1.06–2.56), and Combined groups (OR 2.19, 95% CI 1.41–3.39) had significantly higher odds of having no limitations in overall life functioning. Similar associations were observed for lower-extremity function, while associations with other functional domains varied across physical activity groups. Conclusions: In this cross-sectional study, meeting the recommended levels of aerobic physical activity, muscle-strengthening exercise, or both was associated with higher odds of having no limitations in overall life functioning and lower-extremity function. Full article

Background: People living with multiple sclerosis (MS) are increasingly turning to the Internet for information about their condition and its treatment. However, online health information varies widely in quality, and patients often lack the eHealth literacy needed to distinguish reliable from unreliable sources. Objective: This study examined how people with MS in the United Kingdom seek, evaluate, and judge the quality of online health information, with particular attention to information about medicines, and explored the features that they would value in a curated, quality-assessed information resource. Methods: A cross-sectional online survey was distributed via the MS Trust to adults with MS or their carers in the United Kingdom. The 55-item instrument, adapted from a previously validated questionnaire, captured demographic characteristics, Internet use, eHealth confidence, perceived quality indicators, assessment difficulties, and preferences for a curated information resource. Descriptive statistics summarised the sample, and Spearman’s rank-order correlation tested associations between confidence, perceived importance of quality, and information-checking behaviours. Results: One hundred and fifty-two participants completed the survey. Because the number of individuals reached through the MS Trust’s distribution channels was not recorded, a true response rate could not be calculated; the achieved sample represented approximately 38–40% of the a priori target of 400. Almost all participants (99%) used the Internet to find MS-related information, and 84% sought information about their medicines online. Recommendation by a healthcare professional was the strongest indicator of perceived information quality (17.8%), and MS specialists were the most trusted source overall (32.9%). However, 54.4% of participants expressed concerns about online information quality, and only 47.9% believed that search engines reliably returned high-quality websites. Confidence in evaluating online medicine information correlated strongly and positively with the perceived importance of information quality (ρ = 0.869, p < 0.001, n = 73) and with active checking behaviour (ρ = 0.677, p < 0.001, n = 73). Eighty-eight percent of participants endorsed the development of a single, quality-assessed website for MS-related medicine information, and 80% wished for visible details of how each source had been assessed. Conclusions: Despite high engagement with online information, people with MS remain uncertain about its quality and find independent assessment time-consuming and complex. A curated, transparently assessed information resource, ideally with clinician endorsement and visible quality indicators, was endorsed by the subset of participants who reached these items and represents a candidate direction for future digital health interventions in MS care. Because several preference items were answered by small subgroups (n = 35–79) drawn from an engaged charity membership, these findings are exploratory and require confirmation in more representative samples. Full article

Background: Dual-method menstrual hygiene use, defined as the use of both modern menstrual hygiene products (e.g., sanitary pads) and traditional materials (e.g., cloth), remains under-researched among young women in India. While socioeconomic factors are associated with menstrual practices, religious affiliation may also be associated with differences in reported material use. This study examined the association between religious affiliation and dual-method use among women aged 15–24 years using nationally representative survey data supplemented by contextual evidence from the qualitative and contextual literature. Methods: Quantitative analysis used nationally representative National Family Health Survey-V (NFHS-V, 2019–21) data for 240,230 women aged 15–24 years. Survey-weighted bivariate and multivariable logistic regression analyses estimated the prevalence and adjusted odds of reported dual-method use across sociodemographic and religious groups. Seven purposively selected qualitative and contextual sources were used to provide contextual insights into the quantitative findings. Results: Muslim women had the highest prevalence of reported dual-method use (31.7%), compared with 27.5% among Hindu women and 21.6% among other religious groups. The association between religious affiliation and dual-method use was also observed across several demographic subgroups. Among women with improved toilet facilities, dual-method use was higher among Muslim women than Hindu women (32.3% vs. 27.0%). Similarly, among women with higher education, prevalence was 30.1% among Muslim women compared with 23.3% among Hindu women. After adjustment for measured sociodemographic, socioeconomic, structural, and regional characteristics, Muslim women had 36% higher odds of reported dual-method use than Hindu women (AOR 1.36, 95% CI: 1.29–1.43; p < 0.001). The qualitative and contextual literature provided contextual insights into the potential roles of privacy, household expectations, and disposal concerns in menstrual material use. However, NFHS-V cannot establish whether materials were used concurrently or sequentially or identify the specific contexts of use. Conclusions: Religious affiliation was associated with dual-method menstrual hygiene use after adjustment for socioeconomic and demographic characteristics. The findings indicate that menstrual health interventions should address socioeconomic barriers alongside the social and cultural contexts in which menstrual practices occur. Community-informed approaches incorporating privacy, disposal, household norms, and infrastructure may complement product provision and contribute to more equitable menstrual health outcomes. Full article

Aim: This study addressed two research questions. First, which sociodemographic, behavioral, and psychological factors are independently associated with elevated depressive symptoms among Korean women aged 20–59 years? Second, does subjective perception of one’s own body size retain an independent association with depressive symptoms after these factors are taken into account, and does this pattern differ between younger and midlife women? The primary outcome was elevated depressive symptoms, defined as a PHQ-9 score of 5 or above. Design: This cross-sectional study used pooled data from the four Korea National Health and Nutrition Examination Survey cycles in which the PHQ-9 was administered (2014, 2016, 2018, and 2020). All estimates incorporate the complex survey design and therefore refer to the national population of Korean women aged 20–59 years. Methods: We analysed data from Korean women aged 20–59 years who completed the PHQ-9 (n = 7595). Elevated depressive symptoms were defined as a PHQ-9 score of 5 or above, indicating mild or greater symptomatology. Design-based multivariable logistic regression models were constructed in sequential blocks: demographic variables (Model 1); behavioural and psychological factors added (Model 2); and perceived body size, entered as indicator contrasts against average body size, added (Model 3). Analyses were stratified by age group (20–39 and 40–59 years), and age-group interaction terms were fitted in a pooled model to test formally whether associations differed across the female lifespan. Results: The weighted prevalence of elevated depressive symptoms (PHQ-9 ≥ 5) was 24.1% (95% CI 22.8–25.3). In bivariate analyses, perceived body size differed significantly between women with and without elevated depressive symptoms (p < 0.001). After adjustment for behavioural and psychological factors, neither perceived thinness nor perceived obesity was associated with depressive symptoms in either age group (20–39 years, thin: OR 1.25, 95% CI 0.92–1.69; obese: OR 1.05, 95% CI 0.85–1.30; 40–59 years, thin: OR 1.21, 95% CI 0.84–1.73; obese: OR 0.99, 95% CI 0.80–1.22), and the joint two-degree-of-freedom test was non-significant in both groups. Perceived stress (OR 5.15 and 4.93), poor subjective health (OR 2.11 and 2.55), and lifetime smoking experience (OR 1.75 and 1.79) showed the strongest and most consistent associations in both groups (all p < 0.001). Lower household income was associated with depressive symptoms among women aged 40–59 years and heavy episodic drinking among those aged 20–39 years; in formal interaction testing, household income showed only a non-significant trend towards effect modification by age (p = 0.060), so the age differences are described rather than established. Conclusions: The crude association between perceived body size and depressive symptoms did not persist after adjustment for behavioral and psychological factors. Because perceived stress and subjective health may lie on a causal pathway from body size perception to depressive symptoms, this attenuation is consistent with either confounding or an indirect pathway, and the present cross-sectional design cannot distinguish between them. Perceived stress and subjective health showed the strongest associations across age groups, while lower household income remained an independent correlate in midlife. This finding points to a material condition that individual-level screening cannot by itself address. Full article

Homeownership has become increasingly difficult for many college graduates in the United States. This quantitative study examines the conditional associations among undergraduate major, post-college income, student loan debt, and homeownership using restricted data from the 2021 College and Beyond II Alumni Survey. Grounded in Human Capital Theory and informed by Status Attainment Theory as a secondary interpretive perspective, the study analyzes a sample of 2513 college graduates approximately a decade after degree completion. Logistic regression models examine differences in the conditional odds of homeownership across undergraduate major categories while accounting for post-college economics, student loans, and demographic characteristics. The findings indicate that arts and humanities graduates had lower conditional odds of homeownership than graduates did in the STEM-health, business, education, and social science fields. Higher salary and other household income were associated with higher conditional odds of homeownership, whereas student loan default and higher monthly loan payments were associated with lower conditional odds. Ever borrowing was also positively associated with homeownership, although this relationship should not be interpreted as evidence that student borrowing causes or facilitates homeownership. The findings highlight the complex relationships among educational pathways, post-college economic circumstances, student loan experiences, and homeownership and underscore the need for further research on the long-term financial outcomes associated with higher education. Full article

Purpose: Young adult cancer survivors aged 20–30 years are at increased risk for chronic health conditions, influenced by modifiable lifestyle behaviors. Many do not meet the American Cancer Society’s guidelines for physical activity and healthy eating. Guided by Social Cognitive Theory, this qualitative study explored the facilitators and barriers to healthy lifestyle behaviors among a racially and ethnically diverse sample of young adult cancer survivors aged 20–30 years to inform tailored interventions. Methods: Participants were recruited through the Adolescent and Young Adult Oncology Program at Moffitt Cancer Center in Florida, USA. Semi-structured interviews were conducted and analyzed using applied thematic analysis. Transcripts were coded in NVivo 12 Plus and organized into themes reflecting Social Cognitive Theory constructs and intervention preferences. Demographic information was collected via pre-interview surveys. Results: Participants (N = 30) were an average of 26 years (SD = 2.4). Most identified as non-Hispanic (60%), White (60%), unmarried (83%), women (83%), and with annual household income ≥$40,000 (67%). The most common diagnoses were thyroid cancer (20%), lymphoid (17%), and sarcoma (13%). Interviews lasted 30–88 min (M = 52). Five themes emerged: (1) competing demands and time constraints; (2) symptom burden and desire for credible, flexible support; (3) previous habits, self-efficacy, and community building; (4) dual role of social support; and (5) cancer as a catalyst for behavior change. Conclusions: Findings identified facilitators and barriers to physical activity and healthy eating, and intervention preferences among young adult cancer survivors, which can inform the timing, content, and modality of tailored interventions. Implications for Cancer Survivors: Findings can inform tailored, survivor-centered interventions for young adult cancer survivors. Full article

Background/Objectives: A parsimonious multivariable model was engineered and externally validated using dental electronic health records to screen for a clinician-evaluated “gum disease or related problem” status. Designed for seamless electronic integration, a positive screening result triggers a targeted referral—and the model is well-suited for dental hygienist use— while providing clinical decision support for dentists during definitive diagnoses. This automated support standardises workflows, maximises team efficiency, and supports data-driven clinical decision-making. Methods: This cross-sectional study developed the model using the US National Health and Nutrition Examination Survey (NHANES) 2011–2012 cohort (n = 1732) and independently validated it on the 2013–2014 replication cycle (n = 1855) for the high-risk 30–50-year-old demographic. Survey-weighted logistic regression incorporated age, gender, and eight targeted molar probing depth (PD) measurements paired with binary indicators for tooth presence to predict whether an individual has a gum disease or related problem. Results: External validation demonstrated high parameter generalisability, yielding a pooled population-level AUC of 0.859 (95% CI: 0.828–0.885). At the prevalence-matched threshold of Pt = 0.367, the framework yielded a sensitivity of 78.39% (95% CI: 69.48–85.29%) and a specificity of 79.10% (95% CI: 74.55–83.04%). Demonstrating public health utility via Decision Curve Analysis, the model avoided approximately 39 unnecessary clinical examinations by a dentist per 100 individuals at a practical clinical decision threshold of 0.33, achieving a substantial pooled net benefit compared with a treat-all strategy without compromising case-detection metrics. Conclusions: This scalable screening model offers a highly practical pathway for gum disease and related problem interception. Optimised for seamless software integration, the framework facilitates rapid, hygienist-led risk stratification without increasing chairside burden, and delivers objective data streams to reinforce the dentist’s definitive diagnostic workflow. Full article

Background: Free produce distributions at safety-net health center sites represent a promising strategy for mitigating food insecurity. Understanding how these services connect to participant outcomes is essential for optimizing food delivery to the community. Objectives: In this secondary analysis of Los Angeles County FoodRx Clinic’s Produce Distribution Program (PDP), we evaluated the association between attendance frequency and the proportion of produce consumed (“all” versus “less than all”) among returning participants, adjusting for socio-demographic, household, and program characteristics. Additionally, we sought to identify factors contributing to incomplete produce consumption. Methods: Data were collected using intercept surveys at 16 healthcare sites hosting produce distributions from July to October 2024. Among 451 surveyed participants, 368 were repeat attendees who had visited the distribution events more than once in the last 12 months. Results: Among repeat attendees, 64% reported their household consumed all produce received, while 36% consumed only a portion. Higher attendance frequency (4+ times vs. 2–3 times) was associated with significantly higher odds of all produce consumed (adjusted odds ratio: 2.38, confidence interval: 1.43–3.95). Conclusions: These findings provide critical insights for refining PDP operations and minimizing incomplete produce consumption among repeat attendees of this program. Full article

Background: Mothers of children with autism spectrum disorder (ASD) face numerous challenges in meeting their children’s needs. This study aimed to assess parent-reported child behavioural and emotional outcomes and the levels of anxiety, depression, and stress among mothers of children with ASD. It also explored the correlations between parent-reported child behavioural and emotional outcomes and maternal mental health, as well as potential factors associated with these outcomes. Methods: A cross-sectional study was conducted between 30 December 2022 and 23 March 2023. An online questionnaire was distributed through autism associations across Saudi Arabia. The survey included (1) demographic data; (2) the Autism Family Experience Questionnaire (AFEQ) for children’s behavioural and emotional outcomes; and (3) the Depression, Anxiety, and Stress Scale-21 (DASS-21). Statistical analyses were performed using Jamovi software. Results: The study included 218 mothers of children with ASD. Extremely severe anxiety was reported by 41.3% of mothers, while 30.7% had normal stress and 30.7% had normal depression scores. The mean AFEQ symptom score was 37.4 ± 5.02. Univariate analysis revealed significant associations between parent-reported child behavioural and emotional outcomes and maternal mental health. In the multivariate analysis, higher family income (5000–10,000 SAR, p < 0.001; >10,000 SAR, p = 0.009) was associated with more favourable outcomes, while having more than one child with ASD was associated with less favourable outcomes (p = 0.015). Anxiety was positively associated with having two (p = 0.003) or three children (p = 0.029), while depression was negatively associated with having more than three children (p = 0.001). Conclusions: Higher family income was associated with more favourable parent-reported child behavioural and emotional outcomes, whereas having more than one child with ASD was associated with less favourable outcomes and higher maternal anxiety. Full article

Acculturative family distancing (AFD), characterized by communication gaps and cultural value differences between immigrant parents and their children, has been identified as a potential contributor to mental health disparities among Asian American populations. However, limited research has examined its role among South Asian Americans. This study aimed to assess the association between AFD and symptoms of depression, anxiety, and self-harm in this population. A cross-sectional, anonymous survey was administered to 673 South Asian female college students across the United States. Validated measures included the PHQ-9 for depression, GAD-7 for anxiety, and an adapted AFD scale focusing on communication. Multivariable regression models with a single outcome variable and logistic regression models were used to examine associations between AFD and mental health outcomes, adjusting for demographic factors. Higher AFD scores were significantly associated with increased depressive scores (β = 0.122, p < 0.001), anxiety symptoms (β = 0.102, p < 0.001), and greater odds of self-harm (OR = 1.064, p < 0.001). These findings suggest that AFD represents a meaningful form of psychological disconnection that is associated with increased vulnerability to mental health challenges. Interventions addressing emotional connection within families may be critical for improving mental health outcomes among South Asian American women. Full article

Myopia is a growing public health problem expected to affect half the global population by 2050, making appropriate management of the condition necessary. Therefore, the purpose of this study was to investigate the knowledge and practices of South African optometrists regarding childhood myopia management. A quantitative, cross-sectional, descriptive design with a survey method was employed. An online questionnaire was distributed to practicing optometrists and included questions related to demographic information, knowledge of myopia and associated ocular pathologies, diagnostic work-up and management of childhood myopia. Data were summarised using descriptive statistics, and further analysed with univariate binary and ordinal logistic regression analysis where the independent variables were years of experience, certification and interest. A total of 124 completed questionnaires were received. The majority of participants used non-cycloplegic refraction and less than 20% performed dilated fundus examinations. Single vision distance spectacles were most commonly prescribed despite awareness of the efficacy of interventions to slow myopia progression. However, factors such as cost and the need for clinical guidelines limit the practice of evidence-based management. Participants were aware of some of the ocular pathologies associated with high myopia, indicating that this knowledge needs to be reinforced. Results from this study may be used to aid optometry policy development, regulatory council decisions and guide the content of professional development programmes to enhance knowledge. Full article

Introduction: As seasonal influenza vaccination coverage among healthcare workers (HCWs) in Serbia remains suboptimal, we aimed to identify HCW beliefs associated with their intention to receive seasonal influenza vaccine (“vaccination intention”) in the season 2024/2025. Methods: In a cross-sectional survey conducted in 2024, healthcare institutions were selected from a national registry, using multi-stage sampling stratified by geographical region and healthcare level. All consenting HCWs present on the survey day self-completed questionnaires. Five dichotomised Health Belief Model constructs were assessed: perceived susceptibility to influenza, perceived disease severity, perceived vaccination benefits, perceived physical and psychological barriers, and perceived cues for action (recommendation by another HCW, someone close, or a supervisor). The association of vaccination intention (yes/no/undecided) with Health Belief Model constructs, demographic and occupational factors were assessed using multinomial logistic regression. Results: Of 1919 respondents, 30% declared positive vaccination intention, 52.5% no intention, and 17.5% were undecided. Compared with no intention, positive vaccination intention was associated with perceived self-benefit (aOR = 6.22, CI = 3.49–11.08), perceived patient benefit (aOR = 2.26, CI = 1.48–3.45), perceived susceptibility (aOR = 3.26, CI = 2.19–4.86), and perceived vaccine safety (aOR = 2.95, CI = 1.93–4.50). Participants were more likely to be undecided than reject vaccination if they experienced higher perceived susceptibility (aOR = 2.93, CI = 1.89–4.54), perceived influenza as severe (aOR = 2.04, CI = 1.30–3.21), perceived patient benefits (aOR = 1.77, CI = 1.14–2.74), or recalled receiving a recommendation from another HCW (aOR = 2.63, CI = 1.17–5.85). Conclusions: HCWs’ positive vaccination intention was associated with beliefs relevant for personal health and patient benefits. The undecided group showed a distinct pattern of beliefs warranting their separate analysis and specific approaches. Full article

Background/Objectives: Diet is a modifiable determinant of kidney health, and sex differences in kidney physiology support sex-specific evaluation of dietary patterns. We examined the association of Planetary Health Diet Index (PHDI) adherence with cystatin C-based eGFR decline, and its modification by sex, in US adults aged 50 years and older. Methods: We analyzed 2126 Health and Retirement Study participants (950 men, 1176 women) with diet assessed by food frequency questionnaire in 2013 and cystatin C-based eGFR measured in 2012 and 2016. Survey-weighted regression models, adjusted for baseline eGFR and for demographic, socioeconomic, lifestyle and clinical covariates, related PHDI to eGFR change and to a ≥30% relative eGFR decline; sex interaction was tested on the multiplicative and additive scales. Results: PHDI adherence was nonsignificantly associated with lower eGFR decline (β per 10-point increment 0.218; 95% CI −0.065 to 0.466). Among women, each 10-point-higher score was associated with slower eGFR decline (β 0.355; 95% CI 0.029 to 0.681; p = 0.034) and 20% lower odds of ≥30% eGFR decline (OR 0.799; 95% CI 0.687 to 0.930; p = 0.005); no significant association was observed in men (β 0.080; 95% CI −0.294 to 0.454; OR 1.080; 95% CI 0.901 to 1.295). Sex modified the association with ≥30% eGFR decline on both a multiplicative (p = 0.002) and additive scale (p < 0.001). Conclusions: PHDI adherence was associated with slower kidney function decline in women aged 50 years and older, with non-significant effect in men. Sex merits consideration as a biological modifier when plant-forward diets are evaluated as potentially nephroprotective strategies. Full article

Background/Objectives: A restrictive spirometric pattern (RSP), characterized by reduced forced vital capacity (FVC) with a preserved FEV1/FVC ratio, has been associated with adverse health outcomes and metabolic disorders. This study investigated differences in the prevalence of RSP and pulmonary function between 2019 and 2024 among Korean adults. Methods: This cross-sectional study analyzed data from the 2019 and 2024 Korea National Health and Nutrition Examination Survey. A total of 4856 adults aged ≥40 years without chronic obstructive pulmonary disease were included. RSP was defined as FVC < 80% predicted among participants with an FEV1/FVC ratio ≥ 0.70. Pulmonary function and RSP prevalence were compared between survey years using complex sample analyses. Multivariable logistic regression was performed to examine the association between the post-pandemic period and RSP. Results: The prevalence of RSP increased significantly from 2.31% in 2019 to 3.58% in 2024 (p = 0.025). FVC, FEV1, and FVC percent predicted significantly decreased after the COVID-19 pandemic (all p < 0.001), whereas the FEV1/FVC ratio (p = 0.166) and peak expiratory flow (p = 0.671) remained unchanged. After adjustment for demographic characteristics, health behaviors, and metabolic factors, the post-pandemic period remained independently associated with RSP (odds ratio, 1.571; 95% confidence interval, 1.036–2.380; p = 0.033). Conclusions: The prevalence of RSP increased significantly after the COVID-19 pandemic and was accompanied by declines in lung volume-related pulmonary function without evidence of increased airflow obstruction. These findings highlight the importance of strategies targeting metabolic health, obesity, and physical function to preserve respiratory health in the post-pandemic era. Full article