Search Results (2,437)

Background and Objectives: Sarcopenia is highly prevalent among older adults with chronic kidney disease (CKD) and is associated with adverse clinical outcomes. The finger-ring (Yubi-wakka) test is a simple anthropometric screening tool based on calf circumference; however, its performance in older adults with CKD remains unclear. This study aimed to investigate the association of the finger-ring test with low muscle mass, sarcopenia, and comprehensive geriatric assessment parameters and to evaluate its diagnostic performance for identifying low muscle mass in older adults with CKD. Materials and Methods: This cross-sectional study included 115 patients aged ≥65 years with CKD who were evaluated in geriatric and nephrology inpatient services. After excluding two participants with missing finger-ring measurements, 113 individuals were analyzed. Muscle mass was assessed using bioelectrical impedance analysis and low muscle mass was defined according to EWGSOP2-based Turkish cut-off values. Demographic characteristics, anthropometric measurements, laboratory findings, and comprehensive geriatric assessment parameters were recorded. Correlation analyses, logistic regression models, receiver operating characteristic (ROC) analyses, and likelihood-ratio tests were performed. Results: Among 113 participants, 62 were classified as finger-ring positive (FR = 0) and 51 as finger-ring negative (FR = 1). Low muscle mass was significantly more frequent in the FR = 0 group than in the FR = 1 group (51.6% vs. 24.0%, p = 0.005). Finger-ring test results showed strong correlations with calf circumference (rho = 0.689, p < 0.001) and body mass index (BMI) (rho = 0.631, p < 0.001), whereas the correlation with muscle mass was modest (rho = 0.250, p = 0.008). For detecting low muscle mass, the finger-ring test demonstrated an area under the curve (AUC) of 0.643 (95% CI 0.554–0.732), sensitivity of 72.7%, specificity of 55.9%, positive predictive value of 51.6%, and negative predictive value of 76.0%. In multivariable analyses, BMI remained the strongest independent determinant of finger-ring test results, whereas the association with muscle mass lost statistical significance after BMI adjustment. Adding age and sex significantly improved discrimination, while the contribution of nutritional status was limited. Conclusions: The finger-ring test is associated with low muscle mass in older adults with CKD; however, its diagnostic performance is modest and appears to be substantially influenced by body size and calf circumference. Therefore, the finger-ring test should be considered a simple adjunctive screening tool rather than a stand-alone method for identifying low muscle mass in this population. 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: This study aimed to evaluate the clinical utility of shear wave elastography (SWE) in assessing abscess wall stiffness and its potential contribution to predicting the need for surgical intervention in patients with tubo-ovarian abscess (TOA). Materials and methods: This prospective cross-sectional study included 34 women diagnosed with TOA who underwent SWE evaluation upon admission. Demographic characteristics, laboratory parameters, abscess size, abscess wall elasticity, and abscess content elasticity were recorded. These patients were categorized as either medically managed or surgically treated. Group comparisons, receiver operating characteristic (ROC) curve analysis, and multivariable binary logistic regression were performed to identify independent predictors of surgical intervention. Results: There were no significant differences between the operated and non-operated groups regarding age, body mass index, and laboratory parameters (p > 0.05). The median length of hospital stay was significantly longer in the operated group (15 vs. 12 days, p = 0.017). Abscess diameter was significantly larger in the operated group (6.75 ± 1.17 cm vs. 4.65 ± 1.20 cm; p = 0.001). Likewise, the median abscess wall SWE value was significantly higher in the operated group (3.12 vs. 1.47 kPa; p = 0.027). The optimal cut-off value for abscess wall SWE was 2.04 kPa (AUC: 0.721, 95% CI: 0.551–0.892, sensitivity: 64.7%, specificity: 70.6%). Abscess size demonstrated a higher predictive performance (AUC: 0.905, 95% CI: 0.796–1.000). However, in the multivariable logistic regression analysis, only abscess size remained an independent predictor of surgical intervention (OR: 4.14, 95% CI: 1.50–11.39, p = 0.006), whereas abscess wall SWE and baseline C-reactive protein were not independently associated with treatment failure. Conclusions: Increased abscess wall stiffness measured by SWE was associated with the need for surgical intervention in patients with TOA. Although SWE was not an independent predictor after adjustment for abscess size and baseline C-reactive protein, it may serve as a complementary imaging biomarker when interpreted together with established clinical, laboratory, and conventional ultrasonographic findings. Full article

Background and Objectives: Coronary artery disease may be difficult to detect by resting echocardiography when left ventricular ejection fraction is preserved and regional wall motion abnormalities are absent. This study aimed to assess whether resting Tissue Doppler Imaging-derived mitral annular velocities can help identify CAD in patients with suspected angina pectoris. Materials and Methods: We conducted a cross-sectional observational study of 92 patients hospitalized with suspected angina pectoris who underwent elective coronary angiography at the Institute of Cardiovascular Diseases in Timișoara (January 2025–February 2026). Patients with conditions known to affect TDI-derived parameters were excluded, including previous acute coronary syndrome or myocardial revascularization, significant valvular disease, cardiomyopathies, relevant arrhythmias or conduction abnormalities, permanent pacing, reduced ejection fraction, and pericardial disease. Laboratory and echocardiographic data were collected. ROC curve analysis, univariable logistic regression and multivariable logistic regression were performed to evaluate the diagnostic performance of TDI-derived parameters and their independent association with coronary artery disease. Results: Patients with CAD had significantly lower average E′ values (7.4 ± 1.9 vs. 8.9 ± 1.8 cm/s, p < 0.001) and average S′ values [7.0 (IQR 6.0–7.5) vs. 9.0 (IQR 8.1–10.0) cm/s, p < 0.001], together with higher E/E′ ratios [9.33 (IQR 8.23–11.15) vs. 7.87 (IQR 5.93–9.51), p = 0.002]. Average S′ showed the highest discriminative ability for coronary artery disease, with an AUC of 0.899 (95% CI: 0.819–0.952, p < 0.0001). The optimal Youden-derived cut-off was ≤7.5 cm/s, yielding 77.42% sensitivity and 93.33% specificity. After adjustment for age, male sex, body mass index, diabetes, smoking status, hypertension and LVEF, dichotomized S′ remained an independent predictor of coronary artery disease (OR = 45.49, 95% CI: 8.03–257.68, p < 0.0001), with an adjusted model AUC of 0.92 and 88.04% correct classification. Conclusions: TDI, particularly S′ velocity, may be a useful resting echocardiographic parameter for identifying CAD in selected patients with preserved LVEF and no resting regional wall motion abnormalities. Rather than serving as a universal diagnostic marker, S′ should be considered a complementary, easily obtainable parameter that may improve non-invasive assessment in this specific clinical setting. Full article

In the digital economy, AI companion platforms integrate upstream AI resources, platform governance, and downstream user engagement, yet sustained emotional interaction does not necessarily translate into paid conversion. To examine this engagement–monetization paradox, this study proposes the Emotion–Barrier–Behavior (EBB) framework as a context-specific integration of relational value, platform frictions, post-adoption continuance, and payment evaluation. A mixed-method design was employed. First, 12,144 online reviews of Xingye, a Chinese AI companion platform, were analyzed through text mining and latent Dirichlet allocation to identify context-specific emotional experiences and usage barriers. Second, structural equation modeling was conducted using survey data from 321 adult respondents. Perceived emotional utility was positively associated with continuance intention but had no significant direct association with willingness to pay; a significant indirect association was observed through continuance intention. Perceived usage barriers were negatively associated with willingness to pay but positively associated with continuance intention and emotional utility in the hypothesized model. However, these barrier-related associations became nonsignificant after controlling for an unmeasured latent method construct and varied across barrier dimensions; they should therefore be interpreted as method-sensitive baseline associations rather than robust structural effects. These cross-sectional findings suggest that continued use and payment intention may diverge in AI companion platforms. The study therefore frames sustainable monetization not as revenue persistence alone, but as commercially viable value capture aligned with SDG 3-related user well-being and SDG 12-related responsible digital consumption and platform practices. These SDG-related outcomes were not directly measured, and broader generalization to AI-driven digital platform ecosystems requires further validation. Full article

Background: Functional somatic disorder (FSD) is prevalent, but pathological pathways have not yet been identified. Cross-sectional studies suggest an association between FSD and lipid and glucose metabolism. The aim of the present prospective study was to assess whether metabolic factors represent possible risk factors for development of FSD. Methods: A population-based cohort of 9656 men and women aged 18–76 years was established in 2011–2015, and 5738 participated in a re-examination after a median of 65 months. At both baseline and follow-up, participants answered questionnaires on lifestyle and various delimitations of FSD including bodily distress syndrome (BDS), chronic fatigue (CF), chronic widespread pain (CWP), irritable bowel (IB), and multiple chemical sensitivity (MCS). Fasting values of cholesterol, triglycerides, glucose, HbA1c, insulin, and insulin resistance were assessed at baseline and analyzed in relation to incidence of FSD using logistic regression models, adjusted for age, sex, lipid- and glucose-lowering medications, obesity, social status, lifestyle, and sleep quality. Results: Several small, although significant, effects were observed. Lower levels of cholesterol were associated with development of BDS (OR: 0.982 (95% CI: 0.971–0.993)), CF (OR: 0.980 (95% CI: 0.964–0.996)), and CWP without co-morbid FSS among men. Higher levels of triglycerides were associated with development of CF (OR: 1.022 (95% CI: 1.003–1.041)). Glucose and HbA1c levels were not associated with development of FSD. Insulin and HOMA-IR levels were associated with development of CF in a non-linear relation, being negative at lower levels and changing to a positive relation at higher levels. Conclusions: More large-scale cohort studies are necessary to explore whether metabolism could play a role in the pathological pathway of FSD as indicated in the present study. Full article

Background: Cervical cancer screening uptake in Romania remains below 20%, with invasive sampling cited as a major participation barrier. Urinary HPV testing is a non-invasive alternative, but data from Eastern European populations are scarce and reporting stratified by histological grade is inconsistent. Objectives: To evaluate the agreement between paired urinary and clinician-collected cervico-vaginal HPV testing, and to assess the diagnostic performance of urinary HPV testing for biopsy-confirmed cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Methods: Prospective cross-sectional study in three outpatient obstetrics and gynecology clinics (May 2025–May 2026). A total of 230 women aged 25–70 years provided paired cervico-vaginal (PreservCyt^®) and first-void urine (Colli-Pee^®) specimens. To capture the full spectrum of disease probability, participants were recruited across three clinical scenarios: primary screening, cytology triage and HPV-positive triage. A multiplex RT-PCR assay targeted a total of 14 high-risk HPV genotypes, providing separate identification for HPV16 and HPV18, alongside a pooled detection for the remaining 12 high-risk strains. Colposcopy-guided cervical biopsy served as the reference standard. Results: Paired hrHPV testing achieved substantial agreement (κ = 0.696, 95% CI 0.604–0.788), with higher genotype-specific concordance for HPV16 (κ = 0.755) and HPV18 (κ = 0.789). Discordance was directionally asymmetric (30 cervical-positive/urine-negative versus 4 urine-positive/cervical-negative; McNemar p < 0.001). For biopsy-confirmed CIN2+ (59 of 230; 25.7%), urinary hrHPV showed a sensitivity of 86.4% (95% CI 75.5–93.0), specificity 56.7%, positive predictive value 40.8% and negative predictive value 92.4%, compared with 91.5%, 43.3%, 35.8% and 93.7% for cervico-vaginal testing. Urinary HPV positivity increased monotonically with histological severity (25.0% no-lesion, 69.0% CIN1, 86.4% CIN2+; linear-by-linear p < 0.001). Conclusions: Urinary HPV testing demonstrates substantial agreement with clinician-collected sampling, near-equivalent negative predictive value, and a robust dose–response with histological severity. It is a clinically credible non-invasive entry point for a triage cascade in settings such as Romania, where low participation rather than analytical performance is the principal screening barrier. Full article

Using cross-sectional survey data from 15,655 primary school students in China, this study examines whether more intensive parental involvement is associated with greater bullying victimization in school and whether teacher public praise statistically accounts for part of this association. Results from instrumental-variable, exploratory mediation, and moderation analyses suggest that higher parental involvement is linked to greater bullying victimization. Teacher public praise partially mediates this association, and the positive association between parental involvement and bullying victimization is stronger among students with higher emotional sensitivity. Full article

Digital technologies are central to student life, but evidence is limited on whether digital-use scales can provide useful thresholds for identifying psychological distress among medical students. This single-center cross-sectional study analyzed complete data from 600 undergraduates at a medical university in southern Vietnam. Stress, depression, and anxiety symptoms were classified using the DASS-21, while problematic smartphone use, social media use, and gaming-related problems were assessed using the SABAS, BSMAS, and a six-item GAS adaptation, respectively. Receiver operating characteristic analyses and the Youden index were used to estimate discrimination and candidate cut-offs. Non-normal DASS-21 scores were observed for stress (30.4%), depression (37.8%), and anxiety (39.0%), predominantly within the mild range. For stress, the AUCs and cut-offs were 0.75 (95% CI 0.70–0.80; ≥23.5) for SABAS, 0.67 (0.62–0.71; ≥17.5) for BSMAS, and 0.64 (0.60–0.70; ≥15.5) for GAS. For depression, the corresponding values were 0.62 (0.57–0.66; ≥21.5), 0.68 (0.63–0.73; ≥18.5), and 0.60 (0.55–0.65; ≥14.5). For anxiety, they were 0.60 (0.55–0.64; ≥20.5), 0.62 (0.57–0.67; ≥17.5) and 0.55 (0.51–0.60; ≥15.5). Sensitivity was low across thresholds (35.0–59.0%). These candidate cut-offs showed modest discrimination and should be considered only as preliminary behavioral flags prompting validated mental health assessment, not as stand-alone screening or diagnostic criteria. Full article

The morphology of CVD-grown molybdenum disulfide (MoS₂) is sensitive to the local precursor environment, which governs nucleation density, edge stability, and growth kinetics. In this work, we systematically investigate the effect of precursor ratio on the morphological evolution of MoS₂ microstructures synthesized by atmospheric-pressure chemical vapor deposition on SiO₂/Si substrates. By varying the relative amounts of MoO₃ and sulfur precursors, distinct growth regimes were obtained, ranging from compact hexagonal and quasi-circular domains to multilayer hexagonal structures, triangular domains, and dendritic morphologies. At higher MoO₃ loading, growth is dominated by dense nucleation, leading to isolated few-layer hexagonal domains. A moderate reduction in Mo precursor concentration promotes diffusion-assisted growth and secondary nucleation, resulting in multilayer hexagonal structures with aligned or slightly rotated stacked layers. Under sulfur-rich conditions, morphology evolves into triangular domains due to anisotropic edge stabilization, while further increase in sulfur concentration gives rise to branched dendritic structures through kinetically limited, diffusion-dominated growth. Cross-sectional FIB analysis reveals dense vertical stacking and lateral displacement of upper layers in the multilayer hexagonal domains. Raman and photoluminescence measurements confirm strong correlations between morphology, layer thickness, and optical response, with thinner regions exhibiting reduced Raman peak separation, enhanced photoluminescence intensity, and blue-shifted excitonic transitions. The results show that, under fixed APCVD reactor geometry, source positions, temperature profile, carrier-gas flow, and nominal growth duration, the nominal MoO₃ to sulfur source-loading ratio reproducibly correlates with the transition between compact hexagonal, multilayer hexagonal, triangular, and dendritic MoS₂ morphologies on amorphous SiO₂/Si substrates. Because vapor-phase Mo- and S-containing partial pressures were not directly measured, this ratio is treated as a nominal source-inventory descriptor rather than as a direct vapor-phase stoichiometric ratio. The observed trends are interpreted using a qualitative thermodynamic and kinetic framework based on precursor fluence, nucleation density, edge stability, and diffusion-limited growth. Full article

Background: This study aimed to investigate the association between educational attainment and depressive symptoms among young-old adults aged 60–74 years, and to examine the mediating effect of self-reported memory function between them, so as to provide a reference for the early screening and intervention of depressive symptom severity in this population. Methods: This was a cross-sectional study, and data were derived from the 2022 China Family Panel Studies (CFPS). After data cleaning, 3666 valid samples were included. Depressive symptom severity was assessed using the 8-item Center for Epidemiologic Studies Depression Scale (CES-D 8) (Cronbach’s α = 0.771, Guttman Split-Half Coefficient = 0.742), with a total score ≥ 9 defined as probable depression. Self-reported memory function was measured using a single item (scored 0–4), with higher scores indicating better perceived memory, and was treated as a continuous variable for analysis. Descriptive statistics and Pearson correlation analysis were performed using R software (version 4.2.3). The mediation effect was tested using the product-of-coefficients method combined with the bootstrap method (5000 resamples), supplemented by a quasi-Bayesian model and multiple sensitivity analyses (including outcome variable substitution and model diagnostic corrections) for robustness testing. Results: Among the study participants, the prevalence of probable depression was 25.18%. Correlation analyses showed that educational attainment was significantly negatively correlated with depressive symptom severity (r = −0.177, p < 0.001) and significantly positively correlated with self-reported memory function (r = 0.241, p < 0.001). Self-reported memory function was significantly negatively correlated with depressive symptom severity (r = −0.223, p < 0.001). After adjusting for age, gender, place of residence, subjective income, self-rated health, and chronic disease status, mediation analysis showed that the direct effect of educational attainment on depressive symptom severity was −0.297 (95% CI: −0.424 to −0.174), while the indirect effect via self-reported memory function was −0.109 (95% CI: −0.139 to −0.082). The direct and indirect effects accounted for 73.20% and 26.80% of the total effect, respectively; the results of the quasi-Bayesian analysis and multiple sensitivity analyses were consistent in direction, further validating the stability of this mediation effect. Conclusions: Among young-old adults aged 60–74 years, self-reported memory function plays a partial statistical mediating role in the association between educational attainment and depressive symptom severity. This suggests that strengthening attention to memory status and early screening among individuals with lower educational attainment may offer a potential intervention approach for alleviating depressive symptom severity in this population in the future. Full article

Background/Objectives: Community psychiatric care aims to support recovery, autonomy, and lower reliance on inpatient services, but co-occurring substance use may reduce these gains. This study examined associations between psychiatric care pathway, non-tobacco substance-use severity, recovery-related patient-reported outcomes, clinical instability, and direct mental health cost in adults with severe mental illness in Romania. Methods: This cross-sectional observational study included 128 adults receiving psychiatric hospital care, long-term residential care, or protected community housing within one regional psychiatric care network. Participants had at least 12 months of uninterrupted care in their current setting. Substance use was assessed with the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), excluding tobacco from the analytic severity score. Outcomes included SF-36 physical and mental scores, brief service-experience ratings of autonomy and perceived coercion, emergency department visits, relapse, readmission, inpatient days, outpatient visits, and annual direct mental health cost. Results: Any non-tobacco substance use was most common in hospital care, intermediate in residential care, and least common in community housing. Mental quality of life was lowest among hospital participants with substance use and highest among community participants without substance use. In multivariable models, ASSIST-derived severity was independently associated with a lower SF-36 mental score and a higher direct cost, while autonomy was independently associated with better mental quality of life and lower direct cost. The cost outcome was modeled primarily with a gamma generalized linear model with a log link because costs were positive and right-skewed. Because pathway allocation was clinically determined rather than randomized, and because autonomy, perceived coercion, and mental quality of life were all self-reported at a single assessment, every multivariable and path estimate is exploratory. Conclusions: Community psychiatric pathways were associated with more favorable recovery indicators, but non-tobacco substance use remained an important marker of poorer outcomes and greater service burden. The findings support addiction-sensitive community psychiatric care and routine monitoring of autonomy and perceived coercion as service-quality indicators. Because the design was cross-sectional and the care pathways were non-equivalent at baseline, these results are hypothesis-generating and do not establish that care pathway, substance use, or autonomy exerts a causal effect on any outcome measured. Full article

(1) Background: Prehospital emergency workers frequently experience workplace violence and trauma, raising their risk of post-traumatic stress disorder (PTSD) symptoms and burnout, yet their link to quiet quitting remains poorly understood. We tested whether the PTSD–quiet quitting association is statistically patterned through perceived occupational stress and emotional exhaustion. (2) Methods: In a cross-sectional online survey, prehospital emergency professionals in Türkiye who reported workplace violence within the previous six months completed the PTSD-Short Scale, Perceived Occupational Stress Scale, Job-Related Emotional Exhaustion Scale, and Quiet Quitting Scale. Serial mediation was tested with PROCESS Model 6 (5000 bootstrap resamples), with an age- and gender-adjusted sensitivity analysis, and reporting followed the STROBE checklist. (3) Results: Of 327 respondents, 305 were analysed. PTSD symptoms were associated with quiet quitting (β = 0.460, p < 0.001). With both mediators entered, the direct path was non-significant (β = 0.105, p = 0.071), indicating full statistical mediation. The serial route through stress and exhaustion was the largest indirect pathway (B = 0.155, 95% CI [0.091, 0.217]), and the model explained 42.1% of the variance. Self-reported, single-session data mean the indirect effects are best treated as upper-bound estimates. (4) Conclusions: PTSD symptoms were indirectly related to quiet quitting through occupational stress and emotional exhaustion. The high correlation between the two mediators suggests one broad strain process rather than two distinct stages. Because the design is cross-sectional, it precludes causal ordering; longitudinal studies are needed. Clinically, the findings highlight reducing workplace violence and monitoring stress and exhaustion to limit disengagement among prehospital staff. Full article

Background/Objectives: Sleep health is a key determinant of physical and psychological well-being, yet poor sleep quality remains common, particularly among women. Sociodemographic inequalities and culturally patterned pre-sleep behaviours may contribute to sleep disturbances, but their combined role in Mediterranean populations is still insufficiently understood. This study aimed to examine sleep quality and its associations with sociodemographic characteristics and pre-sleep habits among adult women living in Spain. Methods: A cross-sectional online survey was conducted among 785 Spanish adult women aged 18–64 years. Sleep quality was assessed using the Spanish version of the Pittsburgh Sleep Quality Index (PSQI). Additional questionnaire items collected information on sociodemographic variables and pre-sleep habits, including meal timing, stimulant consumption, physical activity, bedtime routines, screen exposure, and sleeping alone or with company. Data were analysed using chi-square tests, Mann–Whitney U tests, Kruskal–Wallis tests, Spearman’s correlations, and principal component analysis. Results: The mean global PSQI score was 7.5 (SD = 3.01), indicating mildly impaired sleep quality overall. Age showed the largest association with global PSQI score (ε² = 0.052, p < 0.001), followed by income (ε² = 0.010, p = 0.016). Frequent nocturnal awakenings were the most common sleep disturbance, whereas sleep medication use was uncommon. Older age and lower income were associated with poorer sleep outcomes, including shorter sleep duration, lower sleep efficiency, and higher global PSQI scores. Higher education and health-related training were generally associated with more favourable sleep profiles. Pre-sleep habits such as late dinners, stimulant use, and evening screen exposure were highly prevalent but showed weak and non-significant associations with global PSQI scores. Conclusions: In this cross-sectional sample, poorer sleep quality was associated with selected sociodemographic characteristics, whereas isolated pre-sleep behaviours showed weak or non-significant associations with global PSQI scores. Given the study design and non-probability sampling, these findings should be interpreted as associations and generalized with caution. They may inform future studies and support the development of gender-sensitive, non-pharmacological sleep-health strategies that consider socioeconomic and cultural context. Full article

Sleep characteristics have been associated with body mass index (BMI) among adolescents, but population-representative evidence on sleep timing and variation across demographic subgroups remains limited. We conducted a cross-sectional analysis of 2017–2018 California Health Interview Survey data from 880 adolescents aged 12–17 years. Weeknight sleep duration was obtained from the CHIS-derived sleep-duration variable, based on reported school-night bedtimes and school-day wake times. Sleep-timing measures included bedtime, wake time, and the derived sleep midpoint. Pooled survey-weighted linear and logistic regression models used 160 jackknife replicate weights and adjusted for age, sex, race/ethnicity, household poverty category, and survey year; sensitivity models additionally adjusted for dietary and behavioral factors. Sleep duration was not associated with BMI overall (p = 0.161) or with the odds of having overweight or obesity (p = 0.36). The association between sleep duration and BMI varied by age group (p for interaction = 0.042). Each additional hour of sleep was associated with a lower BMI among adolescents aged 14–17 years (β = −0.895 kg/m²; 95% CI: −1.464 to −0.326; p = 0.002), but not among those aged 12–13 years. However, there was no evidence of an interaction when age was modeled continuously (p for interaction = 0.36). Bedtime, wake time, and sleep midpoint were not independently associated with BMI. Exploratory evidence that the association between sleep duration and overweight or obesity varied by race/ethnicity was attenuated after adjustment for dietary and behavioral factors (p for interaction changed from 0.04 to 0.05). In this cross-sectional study, neither sleep duration nor sleep timing was associated with BMI in the overall sample, and sleep duration was not associated with BMI-defined weight status. Subgroup findings were not consistent across model specifications and should be examined in longitudinal studies using objective and repeated measures of sleep. Full article