Search Results (109)

Background: Apathy predicts functional and cognitive decline in community-dwelling older adults. However, the behavioral correlates of apathy, which could promote cognitive decline have not been described. Our objective was to investigate the associations of apathy with leisure and social engagement. Methods: N = 538 older adults enrolled in the Central Control of Mobility in Aging study. We used the GDS3A, a 3-item subscale of the Geriatric Depression Scale, to define apathy and the frequency of participation in cognitive, physical, and social leisure activities. Linear regression models were conducted to assess the association between apathy and its behavioral correlates: social engagement and leisure activity participation. Covariates included age, gender, education level, multimorbidity, and dysphoria. Results: Apathy was present in 29.7% of participants and was significantly associated with less frequent participation in physical activity days per week (−1.688. p = 0.003) but not cognitive (−1.094, p = 0.252) or social (−0.654, p = 0.103) leisure activities. Apathy was also associated with a decreased social behavior composite score (−0.055, p < 0.001), Social Network Index (−0.478, p = 0.003), and Medical Outcomes Study Social Support scores (−0.26, p = 0.001). Conclusions: Our findings suggest that apathy presents with reduced participation in physical leisure activities and reduced social engagement, which may provide a way for clinicians and caregivers to identify apathy in the future. Full article

Technological advancements keep influencing religious landscapes in unpredictable ways. This implies changes at the level of personal spirituality and also at the level of community building and civic engagement across different denominations. In this paper, we present survey data (N = 443) from Malta (Southern Europe), Serbia (Balkans), and Denmark (Northern Europe), which assessed participants’ prayer intensity, Christian identity, Christian belief, and civic engagement behaviors, among other variables. The participants in our sample were all Christians: the participants from Malta were mostly Catholic, those from Serbia were mostly Orthodox, and those from Denmark were mostly Lutheran, reflecting the dominant Christian contexts and denominations in all three countries. We conducted multiple regression analysis showing how prayer intensity predicts civic engagement, even when adjusting for other covariates, notably those tapping Christian identity and Christian belief. The relationship was significant across all three countries. Moreover, we conducted further multiple regression analyses with two prayer intensity sub-indices: one tapping technologically mediated prayer (e.g., using apps or podcasts) and the other tapping non-technologically mediated prayer (e.g., praying directly to God or going to mass). In this model, only non-technologically mediated prayer predicted civic engagement in Malta and Denmark, and no sub-index predicted civic engagement in Serbia. Our discussion focuses on the implications of these patterns for engagement and community building, with a particular focus on religious collectives across denominations and the impact of technology. Full article

This study develops and tests an integrated structural equation model (SEM) linking Butler’s Tourism Area Life Cycle (TALC), residents’ quality of life (QoL), and community participation in sustainable tourism governance (STG) across three emerging island destinations in Aceh, Indonesia. Drawing on survey data from 1266 residents, we employ confirmatory factor analysis and covariance-based SEM to (1) assess the direct effects of TALC-derived dimensions on residents’ QoL; (2) examine the influence of residents’ QoL on governance participation; and (3) evaluate both direct and indirect pathways linking TALC to STG. Rather than distinct life cycle stages, we conceptualize and measure residents’ perceptions of destination maturity based on key TALC dimensions, such as infrastructure development, tourism intensity, and institutional coordination. Results indicate that higher perceived destination maturity is positively associated with residents’ QoL (β = 0.21, p < 0.001), and that residents’ QoL strongly predicts governance participation (β = 0.31, p < 0.001). TALC dimensions also directly affect STG (β = 0.23, p < 0.001), with residents’ QoL partially mediating this relationship and accounting for 22.4% of the total effect. Multigroup SEM reveals consistent effect patterns across Weh, Pulo Aceh, and Simeulue. These findings illustrate how TALC-informed perceptions of destination maturity relate to residents’ quality of life and governance participation, suggesting that perceived well-being may play an important role in shaping community engagement in small-island tourism contexts. Full article

Background: Youth tobacco use remains a significant public health concern, particularly in urban communities disproportionately burdened by health disparities. In Baltimore City, where tobacco-related harms are elevated, understanding the relationship between tobacco use—including e-cigarettes—and mental health among high school students is essential for guiding equitable prevention and cessation strategies. The CEASE (Communities Engaged and Advocating for a Smoke-free Environment) program, in collaboration with the American Lung Association’s Not On Tobacco (N-O-T) initiative, developed an online school-based survey to inform community-responsive interventions. Aims: This study aimed to examine the associations between cigarette use, including conventional cigarette use, and self-rated mental health among high school students in Baltimore City. Methods: High school students in Baltimore City completed an anonymous online survey that assessed demographic characteristics, tobacco knowledge and use, mental health, and related behaviors. Self-rated mental health was dichotomized as poor versus fair/good. Tobacco use categories included current use of e-cigarettes and conventional cigarettes. Logistic regression models were used to examine associations between tobacco use and self-rated mental health, adjusting for age, gender, race, and parental education. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. Results: No statistically significant associations were found between self-rated mental health and e-cigarette use and conventional tobacco use after adjusting for covariates. Conclusions: The absence of a significant association may reflect unique aspects of the social context in Baltimore City, where youth may not use tobacco products as a coping mechanism for mental health challenges. Alternatively, it may be due to limitations in measurement, particularly the use of a single-item mental health assessment. These findings should be considered preliminary. Future research using more comprehensive mental health measures and larger samples is warranted to further explore these complex relationships. Full article

Background/Objectives: Preventive health behaviors are key to disease prevention and health system sustainability; however, population-level factors remain understudied in multilingual regions. South Tyrol, an autonomous multilingual province in Northern Italy, provides a unique setting to examine how sociodemographic and linguistic factors shape preventive behaviors. Methods: A stratified, population-representative survey of 2090 adults (aged ≥18 years) was conducted in South Tyrol in 2024. Preventive behavior was assessed using the validated 16-item Good Health Practices Scale (GHP-16). Key predictors included age, sex, education, living situation, language group, employment in the health/social sector, health literacy (HLS-EU-Q16), patient activation (PAM-10), and the mistrust of professional health information. Weighted statistics and multivariable linear regression were used to identify associations. Results: The GHP-16 scores varied significantly across sociodemographic and psychosocial strata. Female sex, older age, higher education, higher patient activation, and sufficient health literacy were independently associated with greater engagement in preventive behaviors. Patient activation showed the strongest graded effect (β = 1.739). The mistrust of health professionals was inversely associated with behavior (β = –0.050, 95% CI: –0.090 to –0.009). Italian speakers reported higher GHP-16 scores than German speakers (β = 0.377), even after adjusting for covariates. Item-level analysis revealed small but consistent differences, particularly in information-seeking and vaccination behavior. Conclusions: Preventive behaviors in South Tyrol are shaped by demographic, psychosocial, and linguistic factors. Patient activation and health literacy are key modifiable predictors, whereas language group differences suggest structural and trust-related disparities that require tailored public health strategies in multilingual settings. Full article

Adolescents’ performance in high-stakes standardized examinations plays a pivotal role in shaping their educational trajectories. This longitudinal study investigated whether parental attendance at parent–teacher conferences (PTCs) during early adolescence is associated with students’ performance in standardized examinations required for high school and college entrance. Drawing on data from the Taiwan Youth Project, we analyzed responses from 1294 ninth-grade students and 524 twelfth-grade students with available exam results. Parental participation in PTCs was recorded in both seventh and eighth grades, along with two other types of school-based involvement and covariates, such as parental education level, household income, students’ birth order, prior academic rank, peer relationships, parental support, and parental expectations. Hierarchical linear modeling was employed to control for individual and school-level variables. The results showed that parental attendance at PTCs in eighth grade was associated with higher scores on high school entrance exams in ninth grade. Furthermore, attending PTCs in both seventh and eighth grades was significantly associated with better performance in college entrance exams in twelfth grade (β = 3.02, p < 0.01). These findings suggest that sustained parental engagement in PTCs contributes to improved academic performance in adolescence. Policies that promote equitable and continued parent–teacher collaboration may support long-term student success. Full article

Objective: The aim of this study is to determine if protein intake, diet quality, or engagement in physical activity mediate the relationship between sleep quality or duration and handgrip strength. Methods: The sample consisted of 2171 middle-aged persons examined in the 2013–2017 Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) prospective cohort study. Those with sleep apnea (n = 222) and missing data were excluded, resulting in an analytical sample of 1308. Handgrip strength, an objectively measured variable, was determined using a Jamar Hydraulic Hand Dynamometer and expressed relative to body mass index (based on measured height and weight). Sleep quality and duration were measured using the Pittsburgh Sleep Quality Index questionnaire. Protein intake was calculated from two 24 h recalls collected using the USDA Automated Multiple-Pass Method and expressed as g per kg of body weight. Diet quality was assessed using the Healthy Eating Index (HEI) and the energy-adjusted Dietary Inflammatory Index (e-DII). Physical activity was self-reported and expressed as meeting the Life Simple 7 criterion (≥150 min/week, 0–149 min/week, 0 min/week). Mediation analysis was conducted using the Hayes PROCESS macro, model #4, for SPSS Version 4.2. Adjustment for the self-reported covariates of age (years); sex at birth (male, female); race (African American, White); poverty status (<125% or >125% US HHS Poverty Guidelines); current cigarette smoker (yes, no); marijuana, opiate, and/or cocaine user (yes, no); medical conditions including diabetes, hypertension, and/or metabolic syndrome (yes, no); and mean energy (kcal, only protein model) was performed. Results: Protein intake, expressed as g per kg of body weight, mediated the relationship between sleep quality and sleep duration and handgrip strength (indirect effect = −0.0017 ± 0.0006, CI 95% (−0.0030, −0.0006, p < 0.05); indirect effect = 0.0057 ± 0.0019, CI 95% (0.0023, 0.0098, p < 0.05, respectively)). Diet quality, as measured using the HEI, mediated the relationship between sleep duration and handgrip strength (indirect effect = 0.0013 ± 0.0007, CI 95% (0.0001, 0.0030, p < 0.05). Conclusions: Protein intake and a healthy diet mediate the relationship between sleep and handgrip strength, suggesting that these factors may play a role in preserving muscle strength. Full article

Background: Cancer survivors who do not engage in regular physical activity often experience persistent psychological distress and fatigue, which can significantly impact their quality of life. While handgrip strength (HGS) is recognized as an indicator of overall health and physical resilience, the combined role of HGS and physical inactivity in predicting psychological distress and fatigue in this population remains unclear. This study aimed to examine the relationships between self-reported physical inactivity, HGS, and psychological distress, specifically depressive symptoms, anxiety, and cancer-related fatigue (CRF), in physically inactive cancer survivors. Methods: This cross-sectional study included 42 physically inactive cancer survivors (mean age = 63.2 years, SD = 8.96) recruited from the Cancer Institute (IRCCS) in Bari, Italy. Physical inactivity was quantified based on self-reported weekly physical activity minutes, with all participants engaging in less than 150 min per week. The participants underwent HGS assessment and completed validated psychological measures, including the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI-Y1 and STAI-Y2), and the Fatigue Severity Scale (FSS). Results: Bivariate correlations were examined via Spearman’s rank correlation coefficients, and multiple linear regression analyses were performed to identify independent predictors of psychological distress and fatigue, adjusting for covariates such as age, sex, cancer type, and time since treatment completion. Both lower HGS and greater physical inactivity were significantly correlated with greater depressive symptoms (HGS: ρ = −0.524, p < 0.001; physical inactivity: ρ = −0.662, p < 0.001), greater fatigue severity (HGS: ρ = −0.599, p < 0.001; physical inactivity: ρ = −0.662, p < 0.001), and increased trait anxiety (HGS: ρ = −0.532, p < 0.001; physical inactivity: ρ = −0.701, p < 0.001). No significant associations were found between physical inactivity or HGS and state anxiety (p > 0.05). Multiple regression analyses confirmed that both HGS and physical inactivity independently predicted depressive symptoms (HGS: β = −0.435, p = 0.009; physical inactivity: β = −0.518, p = 0.002), trait anxiety (HGS: β = −0.313, p = 0.038; physical inactivity: β = −0.549, p < 0.001), and fatigue (HGS: β = −0.324, p = 0.033; physical inactivity: β = −0.565, p < 0.001), even after adjusting for covariates. Low physical activity and reduced muscle strength independently predict psychological distress and fatigue in cancer survivors. Conclusions: These findings highlight the potential exacerbating role of physical inactivity in both physical and psychological vulnerability, underscoring the need for interventions promoting regular exercise. Integrating strength assessments and structured physical activity programs may be key strategies in survivorship care to improve mental well-being and overall quality of life. Full article

Background: This study aimed to develop a population pharmacokinetic (PK) model that characterized the plasma concentration–time profiles of the total and unbound pamiparib, a PARP inhibitor, in glioblastoma patients and identified patient factors influencing the PK. Methods: The total and unbound pamiparib plasma concentration data were obtained from 41 glioblastoma patients receiving 60 mg of pamiparib twice daily. Nonlinear mixed-effects modeling was performed using Monolix (2024R1) to simultaneously fit the total and unbound drug plasma concentration data. The covariate model was developed by covariate screening using generalized additive modeling followed by stepwise covariate modeling. Model simulations were performed following oral doses of 10–60 mg BID. Results: The total and unbound pamiparib plasma concentration–time profiles were best described by a one-compartment model with first-order absorption and elimination. Creatinine clearance and age were the significant covariates on the apparent volume of distribution (V/F) and apparent clearance (CL/F), respectively, explaining ~22% and ~5% of IIV of V/F and CL/F. Population estimates of the absorption rate constant (Ka), V/F, CL/F, and unbound fraction for the total drug were 1.58 h⁻¹, 44 L, 2.59 L/h, and 0.041. Model simulations suggested that doses as low as 20 mg BID may be adequate for therapeutic effects in a general patient population, assuming that a target engagement ratio (i.e., unbound C_ss,min/IC50) of 5 or above is sufficient for full target engagement. Conclusions: The total and unbound pamiparib plasma PK are well characterized by a linear one-compartment model, with creatinine clearance as the significant covariate on V/F. Model simulations support further clinical investigation into dose reduction to optimize the benefit-to-risk ratio of pamiparib, particularly in combination therapies. Full article

Background/Objectives: This study aims to evaluate the health-related quality of life (HRQoL) of children and adolescent cancer survivors in relation to previously published normative values for typically developing children and adolescents, as well as to analyze the differences in HRQoL based on their levels of physical activity and fitness. Methods: Cross-sectional study with 116 cancer survivors (12.1 ± 3.3 years, 57.8% boys) from two pediatric oncology units in Andalusia (Spain). HRQoL was assessed using PedsQL 4.0 Generic Core Scales. Physical activity was measured with accelerometers, and fitness was evaluated using self-reported and objective tests for muscular fitness. Independent samples t-tests to compare HRQoL between our sample and the normative values published for typically developing children and adolescents of the same age and analysis of covariance (ANCOVA) were conducted to assess differences in HRQoL according to physical activity and fitness categories in our sample. Results: Children and adolescent cancer survivors had lower HRQoL scores compared to typically developing children’s and adolescents’ normative values, except for social functioning. Higher levels of moderate-to-vigorous physical activity were associated with better total, physical, and psychosocial HRQoL scores. Children and adolescent cancer survivors with better levels of cardiorespiratory fitness, motor fitness, and flexibility reported better HRQoL scores in total and psychosocial domains. However, muscular fitness (self-reported and objectively measured) did not show a significant difference in HRQoL. Conclusions: Children and adolescent cancer survivors experience lower HRQoL than their typically developing counterparts. Engaging in at least 30 min of moderate-to-vigorous physical activity per day is associated with fewer HRQoL impairments. Improved fitness, particularly cardiorespiratory fitness, motor fitness, and flexibility, are associated with better HRQoL outcomes. These findings highlight the association between physical activity, fitness levels, and HRQoL in children and adolescent cancer survivors, suggesting the potential benefits of promoting physical activity and enhancing fitness levels. Full article

Background/Objectives: Low physical activity (PA) and excessive sedentary time negatively impact health, contributing to obesity. Physical education (PE) can help reduce the risk of obesity in schoolchildren. This cross-sectional study objectively measured moderate-to-vigorous physical activity (MVPA) and sedentary time during PE in Türkiye, examining the influence of weight status and gender. Method: Accelerometers measured MVPA in 274 children and adolescents (ages 10–14, 49.6% girls). Sedentary time and MVPA were classified based on accelerometer count per 15 s (sedentary: <25; MVPA: ≥574). A two-way Analysis of Covariance (ANCOVA) assessed body mass index (BMI) and gender effects on MVPA and sedentary time. Results: Students spent 44.5% of PE time sedentary and 43.2% in MVPA, below the recommended 50% of PE in MVPA. Only 45.6% met this target (44.2% males and 47.1% females). Overweight/obese students had higher sedentary time, while normal-weight students engaged in more MVPA (p < 0.05). Conclusions: Students did not meet the recommended 50% of PE in MVPA. Increasing MVPA and reducing sedentary time during PE is particularly important for overweight/obese students. Physical education intervention should target students in co-educational classes. Full article

Background and Objectives: Shift work is associated with an increased risk of acute coronary syndrome (ACS) and higher rates of smoking and alcohol consumption. This study examines how smoking and alcohol intake may influence the effect of shift work on ACS risk, indicating a complex interaction among these factors in individuals engaged in shift work. Materials and Methods: This investigation utilized data from the Korean Genome and Epidemiology Study (KoGES). Shift work was the primary exposure, and the main outcome was ACS, defined as either myocardial infarction or angina pectoris diagnosed from 2003 to 2020. Cox proportional regression analysis was employed to assess the impact of shift work, smoking, and alcohol intake on ACS incidence. Additionally, we performed an interaction analysis to examine the effects of shift work in conjunction with smoking and alcohol intake on ACS incidence. Results: Out of 10,038 participants enrolled during the study period, 3696 (36.8%) met the inclusion criteria. The incidence rate of ACS was 11.88 per 1000 person-years in the shift work group compared to 5.96 per 1000 person-years in the non-shift work group. Using Cox proportional logistic regression, shift work was found to be associated with a hazard ratio (HR) of 1.74 (95% CI, 1.20, 2.53) compared to the non-shift work group. Smoking and alcohol consumption did not exhibit a significant HR for ACS incidence, with HRs of 1.31 (95% CI, 0.98, 1.75) and 0.83 (95% CI, 0.65, 1.07), respectively. In the interaction model, after adjusting for other covariates, shift work was not significantly associated with ACS incidence in current smokers (HR 1.05, 95% CI 0.49, 2.23). However, among non-current smokers, shift work emerged as a significant risk factor for ACS incidence (HR 2.26, 95% CI 1.44, 3.55) (p for interaction < 0.01). No interaction was found between alcohol consumption and shift work in relation to ACS incidence. Conclusions: Shift work is an independent risk factor for acute coronary syndrome (ACS), particularly among non-current smokers. This finding highlights the need to address both lifestyle and occupational factors when developing strategies to mitigate ACS risk among shift workers. Employers and policymakers should consider implementing targeted workplace interventions to reduce this risk. These may include optimizing shift schedules to minimize circadian disruption, providing regular health screenings focused on cardiovascular health, and promoting healthy lifestyle habits such as balanced nutrition, regular physical activity, and stress management programs. Additionally, workplace wellness initiatives could focus on reducing other modifiable risk factors, such as providing resources for smoking cessation and limiting exposure to occupational stressors. Integrating these strategies into occupational health policies can contribute to the early detection and prevention of ACS, ultimately improving the cardiovascular health of shift workers. Full article

Introduction: Pakistan is confronted with the formidable challenge of high population growth, which is compounded by cultural norms that prioritize male offspring, leading to adverse implications for family planning efforts and demographic trends. Despite efforts to promote contraception, including a national family planning program, Pakistan continues to struggle with low and stagnant contraceptive prevalence rates among married women. The influence of gender composition on modern contraceptive uptake remains underexplored, necessitating research to elucidate its impact on reproductive behavior. Materials and methods: This study used the dataset of a facility-based cross-sectional survey conducted in six districts of the Sindh and Punjab provinces in Pakistan. A subset of 495 married women of reproductive age seeking health services from March to June 2019 was used for this study. Logistic regression analysis was employed to examine the association between the gender composition of children and modern contraceptive uptake, adjusting for covariates such as province, the age of the women, and the type of health facility. Results: The analysis revealed a significant association between the gender composition of children and modern contraceptive uptake among married women. As the number of daughters increased without sons, the likelihood of contraceptive uptake remained low (adjusted odds ratio [AOR]: 0.12; 95% CI: 0.04–0.34; p < 0.000), while having at least one son substantially increased the odds of contraceptive use (AOR: 19.91; 95% CI: 8.00–49.50; p < 0.000). Notably, the gender composition of having one daughter with two sons had the highest level of contraceptive uptake, potentially because of family composition preferences. Discussion: The findings highlight the pervasive influence of gender composition on reproductive decision-making in Pakistan, with a clear preference for sons driving modern contraceptive behavior. These results underscore the need for targeted interventions to address gender norms and biases while promoting equitable access to family planning services. Engaging men in family planning initiatives is crucial for challenging traditional gender norms and fostering informed decision-making regarding contraception. Conclusions: Gender preference influences modern contraceptive uptake among women in Pakistan, with the strong preference for sons driving reproductive behavior. Addressing gender norms and biases while promoting informed, self-determined choice is essential for enhancing modern contraceptive uptake and achieving sustainable population growth. Targeted interventions, including male engagement strategies, are needed to challenge societal gender norms and empower individuals to make autonomous decisions regarding family planning. Full article

Augmented reality (AR) technology provides context-aware experiences by overlaying digital information onto the real world to enhance learning effectiveness and reduce cognitive load. This study aimed to develop an AR Mobile Learning System (ARMLS) to address the limitations of traditional teaching materials and help elementary-school students learn geometric concepts. The ARMLS was designed based on the fifth-grade mathematics curriculum, covering topics such as definitions, geometric properties, different views of prisms and pyramids, and their relationships. A teaching experiment was conducted to compare students’ learning achievement, motivation, and cognitive load when using the ARMLS versus traditional teaching materials. This study adopted a quasi-experimental design, where four fifth-grade classes were selected from an elementary school in northern Taiwan as experimental subjects. A total of 66 students participated in the experiment, divided into two groups: 32 students from two classes as the experimental group (using the ARMLS) and 34 students from the other two classes as the control group (using traditional teaching materials). In the teaching experiment, data were collected through pre-tests, post-tests, and questionnaires. Achievement tests assessed learning effectiveness, while learning motivation and cognitive load were measured with standardized scales. System satisfaction was evaluated using a questionnaire. The Johnson–Neyman method determined the regions of significance in the analysis of covariance. Independent-sample t-tests evaluated differences in learning motivation and cognitive load between the groups, and descriptive statistics summarized system satisfaction responses. The results indicated that (1) the ARMLS enhanced the learning achievement among low- and moderate-achieving students, (2) there was no significant difference in learning motivation between the two groups, (3) the ARMLS helped reduce students’ cognitive load, and (4) most students expressed satisfaction with the ARMLS according to the questionnaire results. The ARMLS enhances engagement and deepens understanding by making abstract geometry topics more accessible. It effectively overcomes the limitations of traditional teaching materials, providing elementary students with an interactive, hands-on approach to learning geometric concepts. Full article

The ability to communicate effectively in writing and produce clear and cohesive text is a necessary skill in both educational settings and the workplace, yet many young students struggle to organize their thoughts and engage in deep thinking. To address these challenges, an augmented reality (AR) application titled “Explore Wild Animals” has been used to help students organize information; however, it may not accommodate different cognitive styles. Integrating formative peer assessment (FPA) strategy into AR-based instruction can enhance knowledge construction and address diverse cognitive needs. This study, conducted from May to June 2023, empirically investigates the effects of FPA in an AR environment on the writing performance of learners with field-independent (FI) and field-dependent (FD) cognitive styles. A total of 89 fifth-grade pupils from China were randomly assigned to two groups: one group adopting FPA in an AR environment (AR-FPA), and the other group adopting FPA in a conventional PowerPoint (PPT) version 2410 environment (FPA). The results of a two-way analysis of covariance (ANCOVA) indicate that the AR-FPA group outperformed the FPA group in writing performance. Specifically, FI learners benefitted more from the AR-FPA approach, while FD learners performed better with the FPA approach. However, multiple linear regression analysis reveals that the peer feedback quality and features showed little to no significant correlation with feedback providers’ writing performance, regardless of cognitive style. These results highlight the effectiveness of integrating AR and FPA in enhancing educational outcomes, providing practical insights for promoting the sustainability of technology-enhanced learning and teaching practices. Full article