Search Results (4,569)

Background/Objectives: Nurses working in Anaesthesia and Intensive Care Units (AICUs) face high job demands that may negatively affect their well-being and increase turnover intention. In healthcare systems experiencing workforce shortages, such as Romania, understanding these mechanisms is essential for developing effective retention strategies. This study examined the relationship between job demands and turnover intention among Romanian AICU nurses, focusing on the mediating roles of professional fatigue and depressive symptoms. Methods: A cross-sectional survey was conducted among 1001 nurses from the AICUs of 68 Romanian public hospitals. Job demands were measured using a composite index including night shifts, long working hours, schedule changes, exposure to aggressive patients, calls from home, and alarm-related stress. Professional fatigue was assessed as subjective exhaustion after work, depressive symptoms with the Patient Health Questionnaire-9, and turnover intention as the intention to leave the workplace within 12 months. Mediation analyses were performed using PROCESS macro (Model 4) with logistic regression. Results: Job demands were positively associated with turnover intention. Higher job demands predicted increased professional fatigue and depressive symptoms, both significantly associated with turnover intention. Mediation analyses demonstrated significant indirect associations through both professional fatigue and depressive symptoms, indicating partial mediation. Conclusions: Job demands are related to turnover intention among Romanian AICU nurses both directly and indirectly through professional fatigue and depressive symptoms. Retention strategies should address not only workload reduction, but also prevention and coping interventions targeting fatigue and psychological distress. Full article

Background/Objectives: Chronic dust-induced lung diseases, including pneumoconiosis and asbestosis, require long-term monitoring and individualized management. Conventional rehabilitation and follow-up often depend on in-person visits and may not provide continuous assessment outside clinical settings. This scoping review mapped evidence on digital technologies used to monitor patients, assess respiratory symptoms and functional status, and support rehabilitation follow-up in chronic dust-induced lung diseases. Methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Joanna Briggs Institute methodology. PubMed, Scopus, and Web of Science were searched from inception to 29 June 2026 without language restrictions. Five eligible publications were included. Results: The evidence was grouped into three categories: wearable monitoring of activity and respiratory symptoms, analysis of data from a digital rehabilitation platform, and electronic medical record (EMR) analysis. Wearable sensors showed high performance in recognizing basic activity states and cough events under controlled conditions. Platform- and EMR-based approaches showed potential for using clinical and functional data to support patient stratification and monitoring. However, most studies were limited to early technical or algorithmic validation and did not assess long-term home use, patient adherence, integration into clinical workflows, or clinical and rehabilitation outcomes. Conclusions: Digital technologies may support objective monitoring and rehabilitation follow-up in chronic dust-induced lung diseases, but the evidence base remains small and clinically immature. Prospective studies in real-world settings should evaluate usability, external validity, workflow integration, and clinically meaningful outcomes. Full article

Background: Positive behavior during dental treatment does not necessarily indicate the absence of anxiety in children. Behavioral assessment scales, such as the Frankl Behavior Rating Scale, evaluate observable behavior but may fail to identify underlying emotional tension that may accompany dental treatment. Objectives: To evaluate indicators of underlying emotional tension in children classified as cooperative based on the Frankl Behavior Rating Scale (scores 3 and 4) undergoing conventional caries removal or chemo-mechanical excavation with Brix 3000. Methods: Sixty children aged 4–6 years with positive (score 3) or definitely positive (score 4) Frankl behavior were assigned to two treatment groups: conventional caries removal using rotary instruments (n = 30) and chemo-mechanical excavation with Brix 3000 (n = 30). Projective indicators potentially associated with emotional tension were indirectly assessed using the Draw-a-Person Test. Drawings were obtained at home (baseline), immediately before treatment, and immediately after treatment. Figure height was used as a projective indicator that may reflect emotional tension. Results: A marked reduction in figure height was observed immediately before treatment in both groups, consistent with increased emotional tension despite cooperative behavior. Baseline comparison revealed no statistically significant difference between the treatment groups (p = 0.842). Following treatment, figure height increased significantly in both groups. Children treated with Brix 3000 demonstrated significantly greater post-treatment figure heights than those treated with rotary instruments (p = 0.002), suggesting more favorable projective indicators that may reflect lower emotional tension and improved psychological comfort. Conclusions: Cooperative behavior classified by the Frankl Behavior Rating Scale does not exclude the presence of underlying emotional tension that may be associated with anxiety in children undergoing dental treatment. The findings suggest that chemo-mechanical excavation with Brix 3000 may provide greater psychological comfort and potential reduction in indicators consistent with projective indicators of emotional tension than conventional rotary instrumentation. Behavioral assessment alone may not fully capture emotional responses to fully evaluate the emotional state of pediatric dental patients. Full article

Background: Cast removal is an essential but often stressful component of the Ponseti method for idiopathic clubfoot. The impact of different cast removal techniques on infant stress, parental anxiety, and treatment outcomes remains insufficiently explored. Methods: This prospective, quasi-randomized controlled trial included 84 infants with unilateral idiopathic clubfoot treated using the Ponseti method. Patients were allocated to cast removal by oscillating saw in the outpatient clinic (Group 1, n = 42) or by soaking and peeling at home prior to clinic visits (Group 2, n = 42). The primary outcome was the number of casts required to achieve correction and readiness for percutaneous Achilles tenotomy. Secondary outcomes included infant crying time, maximum heart rate during cast removal, parental anxiety assessed using the Short State Anxiety Inventory Scale (SAIS), cast removal time, hospital stay duration, and cast-removal–related complications. Results: There was no significant difference between groups regarding pre- or post-treatment Pirani and Dimeglio scores or the number of casts required (p > 0.05). Infant crying time, heart rate during cast removal, and parental anxiety scores were significantly higher in the oscillating saw group (p < 0.001). Cast-removal–related complications were more frequent in the oscillating saw group (p = 0.003). Conclusions: In this study, home-based soaking and peeling provided clinical outcomes comparable to oscillating saw removal and was associated with lower infant distress markers, lower parental anxiety scores, and fewer observed cast-removal–related complications. These findings suggest that soaking and peeling may represent a family-centered alternative for selected families receiving appropriate instruction. Full article

Oncology care increasingly depends on heterogeneous sensing streams generated by computed tomography (CT), radiotherapy planning systems, wearable devices, home respiratory sensors, patient-reported outcomes, and clinical records. These data streams are often processed separately, limiting their value for longitudinal, context-aware review. This study proposes OncoSense-Agent, a reliability-aware agentic multimodal sensing architecture for CT-guided respiratory monitoring in oncology care. The architecture links CT-derived anatomical evidence with wearable physiology, respiratory symptoms, functional assessment, treatment context, and explainable human-in-the-loop review-priority generation. To move beyond a purely conceptual design, we implemented a lung-focused proof-of-concept with six bounded software agents: Imaging Reliability, Wearable Monitoring, Respiratory Review, Treatment Context, Multimodal Fusion, and Explainability. The prototype used real nnU-Net v2 3D lung segmentation metrics from 139 patients with complete bilateral lung CT data as the imaging anchor, while wearable, respiratory, symptom, and treatment-context channels were introduced as deterministic overlays for controlled validation. OncoSense-Agent changed review-priority assignment relative to CT-only assessment in 78/139 cases (56.1%), assigned 111/139 cases (79.9%) to high-priority or high-uncertainty tiers, and showed increasing Safety Gate activation as CT quality declined. Three illustrative cases demonstrate hidden respiratory deterioration, wearable data-quality uncertainty, and treatment-context risk not captured by CT-only assessment. The prototype does not establish clinical diagnostic accuracy, but demonstrates operational, auditable, reliability-aware multimodal review-priority generation for clinician-supervised oncology monitoring. Full article

Background: Older adults commonly experience a progressive decline in functional capacity and exercise tolerance, particularly among residents of residential care homes. Advanced age is associated with a higher prevalence of coronary heart disease (CHD) and arterial hypertension, both of which further reduce physical activity levels. Evidence indicates that regular, structured physical activity can improve physical functioning and cardiovascular parameters. This study aimed to assess functional capacity and exercise tolerance in residential care home residents with treated arterial hypertension and CHD compared with individuals without cardiovascular disease. Methods: The study included 74 men aged 65–80 years residing in residential care homes. Participants were divided into two groups: Group I consisted of 44 men without diagnosed cardiovascular disease, and Group II included 30 men with diagnosed CHD and arterial hypertension. Functional capacity was assessed using the Short Physical Performance Battery (SPPB), and exercise tolerance was evaluated using the 6-Minute Walk Test (6MWT). Results: The mean SPPB score was 8.7 ± 2.1 points in Group I and 5.2 ± 2.5 points in Group II (p < 0.001). In the 6 MWT, participants in Group I covered a mean distance of 312.7 ± 89.4 m, whereas those in Group II covered 168.4 ± 84.4 m (p < 0.001). Multivariable regression analysis confirmed that group allocation remained an independent predictor of both SPPB and 6MWT outcomes after adjusting for age and somatic parameters (p < 0.001). Conclusions: Residential care home residents with CHD and arterial hypertension demonstrate significantly lower functional capacity and exercise tolerance compared with individuals without cardiovascular disease. Both groups achieved results markedly below national reference values for the Polish older adult population. These findings highlight the need for targeted physical activity programs in residential care homes, with particular emphasis on individuals with cardiovascular disease. Full article

Real-world home monitoring requires sensing systems that can capture daily behaviour without continuous raw-video retention or excessive user burden. However, domestic environments present irregular activity timing, fragmented human presence, asynchronous multimodal events, and privacy-sensitive data management. This study proposes an event-driven multimodal sensing and computing framework for context-aware home monitoring using stereo vision and dietary event anchoring. The framework integrates stereo RGB-based three-dimensional human motion sensing, dining-zone-triggered meal image acquisition, runtime event orchestration, timestamp-based cross-modal synchronization, privacy-aware local storage, and large-language-model-assisted dietary context interpretation. Instead of continuously recording all sensor streams, the system activates and organizes sensing through human presence detection, debounce logic, cooldown-based session control, and dining-zone occupancy events. Meal-related events are used as contextual anchors to associate motion sessions and dietary observations into synchronized behavioural episodes. The prototype was deployed for 11 consecutive days in a real kitchen–dining environment, with the stabilized real-time monitoring phase evaluated from 11 to 14 February 2026. During this phase, the system generated 26 event-driven motion sessions and 51,165 captured pose frames, of which 25,925 were valid. Sustained active sessions accounted for 30.8% of all sessions but contributed 81.5% of captured pose frames, indicating that event-driven orchestration concentrated motion data within behaviourally meaningful activity windows. Eight meal-related records were obtained, seven of which overlapped with motion sessions, resulting in 87.5% meal-event overlap coverage. Structured pose outputs required approximately 550 kB/min, corresponding to about 33 MB/h of recorded pose data. LLM-assisted meal-image interpretation achieved a mean absolute percentage error of 25.44%, supporting its use for coarse dietary-context description rather than precise nutritional quantification. However, this result is interpreted only as evidence for coarse dietary-context description and not as validation of a precise nutritional or clinical dietary assessment method. These results demonstrate the system-level feasibility of transforming irregular domestic observations into structured, temporally indexed, and privacy-aware multimodal behavioural records for future home monitoring applications. Full article

This narrative review explores the interconnected relationship between quality of life (QoL) and satisfaction with nursing care (SNC) among cancer patients, recognizing that cancer’s burden extends beyond survival and significantly affects physical, psychological, and social well-being. A non-systematic search of PubMed, CINAHL, Scopus, and Google Scholar (2000–2025) identified relevant literature using keywords related to oncology nursing, QoL, SNC and patient satisfaction. Inclusion criteria encompassed peer-reviewed studies (quantitative, qualitative, and reviews) involving adult cancer populations and validated assessment instruments. Pediatric and non-nursing studies were excluded. Both QoL and SNC are critical outcomes in cancer care. QoL is an individual’s subjective perception and SNC reflects the patient’s subjective evaluation of how well nursing services align with their expectations, encompassing empathy, competence, and responsiveness. Research consistently demonstrates a strong positive association between high SNC and superior QoL outcomes, particularly through effective pain and symptom management, reducing psychological distress, and fostering patient empowerment. This relationship, however, is moderated by factors such as the patient’s disease stage, the type of care (hospital vs. palliative/home care), and organizational deficits like high nurse workload, which can undermine the delivery of high-quality care. Ultimately, ethical nursing practices are crucial for translating professional duty into positive patient experiences that are favorably linked with both SNC and QoL outcomes for cancer patients. Full article

Background: Exercise rehabilitation (ER) has become an important treatment regimen during the recovery phase of acute ischemic stroke (AIS). Optimal exercise prescriptions for post-stroke motor recovery remain controversial. Methods: PubMed, Embase, the Cochrane Library, and Web of Science were systematically searched through November 2025. The Cochrane risk-of-bias (RoB 1) assessment tool was utilized to assess the risk of bias in the original studies. Results: This study included 66 trials comprising 3675 patients. For balance, whole-body tilting postural training (WTPT), unilateral strength training (UST) and robot-assisted unilateral gait training (RAUGT) showed high SUCRA rankings. Activities of daily living likely improved most with robot-assisted Tai Chi training (RATCT), home rehabilitation guidance (HRG) and robot-assisted gait training (RAGT). Fugl-Meyer Assessment (FMA) gains appeared greatest following robot-assisted hand training with electrical stimulation (RAHT + ES), neural inhibition therapy (NIT) and graded motor imagery with electrical stimulation (GMI + ES). Walking endurance seemed most responsive to visual feedback training (VFT), UST and visual aids training (VAT), while functional mobility showed greatest improvement with tilt sensor-assisted gait training with electrical stimulation (TAGT + ES), gait training (GT) and virtual reality therapy with motor imagery (VRT + MI). Conclusions: This study provides the first comprehensive evidence synthesis evaluating the comparative effectiveness of specific exercise modalities across distinct recovery domains after AIS. Rather than supporting generic interventions, the findings highlight the distinct comparative advantages of various emerging technologies and traditional practices. These results offer an evidence-based framework for clinicians to optimize post-stroke rehabilitation protocols and highlight priority areas for future research on dose–response and long-term outcomes. Full article

Background/Objectives: Falls-prevention advice in primary care does not always lead to a practical next step. We evaluated a brief, non-clinical Falls Conversation package at one urban NHS general practice. Methods: During a 12-week quality improvement/service evaluation, patients aged 65 years or older were offered a baseline reflection survey, written information, a home-safety checklist and, in later Plan-Do-Study-Act (PDSA) cycles, a one-action prompt. The package did not include clinical assessment, treatment, referral or medication review. Matched pre-post outcomes were analysed, with actions and balancing outcomes recorded at four to six weeks. Results: Of 510 eligible patients, 442 were approached, 334 engaged, 295 provided matched pre-post data and 256 completed follow-up. The mean project-specific knowledge score was 1.83 (SD 1.02) before and 2.60 (SD 0.95) immediately after the package, a paired difference of 0.77 out of 4 (95% CI 0.65 to 0.88; Cohen’s d_z = 0.79; p < 0.001). Worry changed by −0.07 out of 5 (95% CI −0.13 to −0.01; d_z = −0.13), and activity avoidance by −3.4 percentage points (95% CI −7.5 to 0.7; p = 0.144). At follow-up, 157/256 participants reported at least one action (61.3%, 95% CI 55.2% to 67.1%); actions were heterogeneous and unverified. Action selection and completion rose descriptively across non-randomised PDSA cohorts. Conclusions: The package appeared feasible to embed in one practice and was associated with higher immediate knowledge scores and patient-reported action. It did not demonstrate reduced falls or clinically meaningful change in fear-related outcomes. Controlled studies using validated measures, objective outcomes and longer follow-up are required. Full article

Depressive symptoms among university students are a growing public health concern, motivating unobtrusive monitoring with smartphone-based digital phenotyping. This study examined whether passively collected behavioral features can identify elevated depressive symptom risk. We collected smartphone sensing data from 36 university students over two weeks, yielding 551 participant-days. We extracted 21 digital phenotyping features, including 14 additional behavioral features and 7 baseline features. Multiple machine learning models were evaluated using repeated bootstrap validation, and participant-independent generalization was further assessed with Leave-One-Subject-Out (LOSO) validation. We also examined PHQ-9 thresholds, class-imbalance mitigation, and feature importance using SHAP. Tree-based ensemble models achieved the best performance under bootstrap validation, and the proposed feature set consistently outperformed the baseline set. However, performance dropped substantially under LOSO validation, indicating that participant-independent generalization remains challenging. Class weighting and SMOTE did not meaningfully improve performance. SHAP analysis identified home-stay behavior and time-of-day smartphone use as the most influential predictors. These findings highlight that participant-independent prediction remains challenging and underscore the importance of rigorous participant-level validation when developing smartphone-based digital phenotyping models. Full article

Background/Objectives: Traumatic spinal injury (TSI) is associated with substantial morbidity, but factors contributing to in-hospital complications remain insufficiently defined. This study evaluated factors associated with in-hospital complications after TSI. Methods: We conducted a retrospective cohort study at a tertiary center (January 2018–May 2025). Among 5380 trauma patients screened by computed tomography, 413 admitted patients with TSI were included. The primary outcome was any documented in-hospital complication. Factors were assessed using multivariable logistic regression and reported as adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results: The median age was 28.0 years, 337 were male (81.6%), and four-wheel motorized vehicle accidents were the most common injury mechanism (57.1%). In-hospital complications occurred in 99 patients (24.0%). Pulmonary infection was most common (9.9%), followed by bloodstream infection (4.4%), urinary tract infection (3.9%), and surgical site infection (3.9%). Compared with patients without complications, those with complications had longer hospital stays, higher ICU admissions, longer ICU stays, and lower discharge home. In multivariate logistic regression, complications were associated with worse AIS grade (OR 1.690, 95% CI 1.241–2.302), inpatient physical therapy requirement (OR 4.385, 95% CI 2.494–7.711), greater number of associated non-spinal injuries (OR 1.729, 95% CI 1.463–2.042), and greater cervical vertebral injury burden (OR 1.479, 95% CI 1.061–2.062). Conclusions: Neurological severity, polytrauma burden, and cervical injury were independently associated with complications, supporting early risk stratification and multidisciplinary prevention in high-risk patients. Findings should be interpreted considering the retrospective single-center design, predominantly young male cohort, low spinal cord injury proportion, and limited post-discharge data. Full article

Background/Objectives: Individualized nursing care is a fundamental component of high-quality healthcare, particularly in geriatric populations. However, its consistent implementation remains challenging, a situation further exacerbated by the COVID-19 pandemic due to increased workloads and resource constraints. This study aimed to assess nurses’ perceptions of individualized care for older adults in Spain and to examine the influence of the workplace ethical climate on these perceptions. Methods: A cross-sectional observational study was conducted using two validated instruments: the Individualized Care Scale–Nurse version (ICS-Nurse) and the Hospital Ethical Climate Survey (HECS). Descriptive and inferential analyses were performed to assess individualized care, ethical workplace climate, and the associations between both constructs. Results: A total of 96 nursing professionals participated in the study. Participants reported an overall favorable perception of individualized care. The highest scores were observed in the clinical situation dimension, whereas lower scores were reported for aspects related to hygiene organization and the incorporation of patients’ preferences. A moderate, positive, and statistically significant association was observed between ethical workplace climate and individualized care, particularly in dimensions related to patients and physicians. Participants working in hospital settings reported higher recent-experience individualized care scores than those working in nursing homes. Conclusions: These results highlight the critical role of an ethical workplace climate in supporting nurses’ capacity to deliver individualized care. They also underscore the need for targeted strategies to strengthen organizational support, enhance interprofessional collaboration—particularly with physicians—and promote training in individualized care practices. Addressing these factors may facilitate more consistent and comprehensive individualized care, especially in long-term care settings where structural challenges persist. Full article

Background: The hemoglobin, albumin, lymphocyte, and platelet (HALP) score is a simple inflammation–nutrition index that has been associated with adverse outcomes in patients with type 2 diabetes mellitus (T2DM). This study investigated the association between the HALP score and poor glycemic control in older adults with T2DM receiving home health care after excluding patients with malnutrition. Methods: This retrospective, cross-sectional study included 201 patients aged ≥65 years with T2DM whose routinely collected home health care records between 15 December 2025 and 15 March 2026 were retrospectively reviewed after ethics committee approval. Poor glycemic control was defined as HbA1c ≥ 8.0%. Logistic regression analyses were performed to identify factors associated with elevated HbA1c levels. A sensitivity analysis including clinically relevant variables was additionally conducted. The discriminative performance of HALP was evaluated using receiver operating characteristic (ROC) curve analysis. Results: The median age was 83 years, 52.2% were male, and 51 patients (25.4%) had elevated HbA1c levels (≥8.0%). In univariate analysis, high HALP was significantly associated with lower odds of elevated HbA1c levels (OR: 0.27; 95% CI: 0.14–0.52; p < 0.001), whereas dementia showed a borderline association (OR: 0.36; 95% CI: 0.12–1.06; p = 0.065). In multivariable analysis, high HALP remained independently associated with lower odds of poor glycemic control (OR: 0.28; 95% CI: 0.14–0.54; p < 0.001). In a sensitivity analysis adjusted for age, sex, Barthel group, and dementia, high HALP maintained its independent association with lower odds of elevated HbA1c levels (OR: 0.30; 95% CI: 0.15–0.59; p = 0.001). The HALP score demonstrated weak to modest discriminative ability for predicting HbA1c ≥ 8.0% (AUC: 0.645; 95% CI: 0.552–0.739; p = 0.002), with 75.3% sensitivity and 45.1% specificity at a cut-off value of 29.24. Conclusions: High HALP was independently associated with better glycemic control in older adults with T2DM receiving home health care. However, given its weak to modest discriminative ability, HALP should be interpreted alongside clinical assessment and routine metabolic parameters rather than as a standalone diagnostic or predictive criterion. Full article

Background: Smith–Magenis syndrome (SMS) is a rare neurodevelopmental disorder characterized by severe sleep disturbances, circadian rhythm dysregulation, and prominent behavioral difficulties. Objective: To examine associations between subjective and objective sleep and circadian characteristics and behavioral difficulties in children with SMS in real life. Methods: Children aged 5–13 years with genetically confirmed SMS were included in a prospective single-center cohort study. Sleep and circadian rhythms were assessed using parent-reported questionnaires (Sleep Disturbance Scale for Children (SDSC), Horne and Östberg Morningness–Eveningness Questionnaire (H&O)) and 15-day home-based wrist actigraphy. Behavioral difficulties were evaluated using the Aberrant Behavior Checklist-Community (ABC-C). Associations between subjective and objective sleep and circadian measures with behavioral difficulties were studied using Spearman correlations for each ABC-C subscale. Results: Among the 20 children included (55% female, mean age 10 ± 2.5 years), 75% were carriers of a 17p11.2 microdeletion and 25% had an RAI1 mutation. Overall, 95% of children were treated with melatonin, 55% with psychostimulants and 20% with beta-blockers. According to the SDSC results, pathological sleep disturbances were present in 14/20 (70%) children and concerned mainly complaints of insomnia (10/20, 50%) and excessive daytime sleepiness (8/20, 40%). The H&O chronotypes confirmed the morning type in 70% of patients. Sleep and circadian measures obtained by actigraphy showed reduced total sleep time in 71% of the children, reduced sleep efficiency in 88%, long wake after sleep onset (WASO > 60 min) in 59%, as well as an early L5 onset (5 h period with the least movements < 23:38) and M10 onset (10 h period with the highest activity levels < 09:12) in 92% and 62% of children, respectively. The behavioral domains of the ABC-C with the highest scores were hyperactivity (mean 52.1, range 2.1–97.9) and irritability, agitation, and crying (mean 46.9, range 17.8–82.2). In the analysis of the relationship between behavior and sleep, a positive correlation was found between sleep disorders and stereotyped behaviors (r = 0.472, p = 0.048), insomnia and irritability, social withdrawal and stereotyped behaviors (r = 0.472, p = 0.048; r = 0.701, p = 0.001; and r = 0.648, p = 0.004, respectively), and non-restorative sleep and inappropriate speech (r = 0.476, p = 0.046). No significant association was found between objective sleep measures and behaviors. While subjective assessments suggested that a stronger morning chronotype was associated with lower irritability (r = −0.565, p = 0.015), actigraphy-derived circadian rhythm analyses revealed that an earlier L5 onset was associated with greater social withdrawal and hyperactivity (r = −0.556, p = 0.048 and r = −0.560, p = 0.049, respectively). Conclusions: The present cohort study of children with SMS studied in real-life conditions, using both objective and subjective measures, shows that patients continued to experience sleep and behavioral disturbances despite treatment. Exploratory analyses identified distinct associations between subjective sleep disturbances, circadian rhythm characteristics, and specific behavioral domains. While subjective sleep disturbances were associated with irritability, stereotypic behavior, and inappropriate speech, circadian rhythm parameters are specifically associated with hyperactivity. Both were also associated with social withdrawal. As these findings arise from an exploratory observational secondary analysis, they should be considered hypothesis-generating and require confirmation in larger prospective studies. If confirmed, they may help identify sleep and circadian rhythm characteristics as potential targets for future interventions in children with SMS. Full article