Search Results (172)

Background: Endocrine therapy (ET) with or without ovarian function suppression (OFS) is a cornerstone treatment for estrogen receptor-positive (ER+) breast cancer (BC) in premenopausal women, but its impact on quality of life (QoL) and sexual health remains a concern. Methods: We conducted a multicenter, prospective, observational study including premenopausal women (≤50 years) diagnosed with stage I–III ER+ BC and treated in private healthcare facilities in Brazil between 2013 and 2023. Patients received ET alone (ET-only) or combined with OFS (OFS-ET). QoL was assessed at baseline and 3, 6, 9, 12, and 24 months using the EORTC QLQ-BR23. Sexual functioning and sexual enjoyment were prespecified primary outcomes. Logistic regression identified factors associated with OFS use, and Fisher’s exact test was applied for categorical comparisons at 24 months. Results: Among 363 patients (80% ET-only, 20% ET + OFS), younger age, advanced stage, and chemotherapy were independently associated with OFS use. Both groups reported early declines in sexual functioning and enjoyment. By 24 months, ET-only patients had returned to baseline, whereas OFS patients remained below baseline. At the item level, no significant differences were observed in sexual desire (51.5% vs. 42.0%; p = 0.33) or enjoyment (26.0% vs. 13.5%; p = 0.20). Lack of sexual activity was more frequent in the OFS group (60.6% vs. 41.2%; p = 0.05). Body image was significantly more impaired with OFS, with a higher proportion of patients reporting feeling less attractive (38.2% vs. 19.9%; p = 0.04) and less feminine (26.5% vs. 11.7%; p = 0.05). Conclusions: ET impairs sexual health in young BC survivors, particularly when combined with OFS. These findings underscore the need for routine sexual health assessments and supportive interventions in survivorship care. Full article

Post-monolingual circumstances are increasing reflecting the growing occurrence of multilingualism, migration, and advancing communication technologies. Cultural groups value maintaining heritage languages while also learning the ones in their new life environments. Heritage language maintenance is, for example, promoted by immigrant parents and grandparents in the Northern Netherlands, as well as in other locations. Maintaining cultural heritage language also needs innovative instructional approaches and pedagogy. This article presents a study exploring the role of peer collaboration in supporting children’s Chinese heritage language use and learning in New York City. Drawn from sociocultural theory and extended in prior research examining peer collaboration in writing development, we focused on understanding the role of peer collaboration in Chinese immigrant children’s Chinese heritage language use in an after-school (Sunday school) program. In collaboration with organizers of the school, our study involved a 30 min peer collaboration writing activity. The activity invited children to collaborate with a peer to write a letter about the fun experiences they had in the Chinese language school. Interaction processes and products were collected and analyzed to address two primary research questions including the following: What are the languages and peer collaboration processes that children in this Chinese language school used in their conversations and in the text of the letters they created together? How did children’s use of Chinese and English during peer collaboration relate to language in the texts they wrote? Results indicated that children played diverse, mutually supportive roles during their collaboration, such as suggesting narrative sequences for the letter, including confirming/agreeing, and correcting and clarifying, although different pairs balanced such strategies somewhat differently. Among numerous findings is that children used Mandarin most frequently when narrating events that they found enjoyable at the Chinese language school. The findings fill a gap in research on multilingual peer collaboration, in particular with Chinese and English in the United States. In addition to those findings, research in an after-school heritage language program provides a model for innovative research in practice. Full article

Background: Patients with early-stage (I–IIIA) resectable non-small cell lung cancer (NSCLC) often experience reduced physical activity (PA) after surgery. PA telecoaching may support a more active lifestyle, but evidence in this population is limited. Objective: To evaluate acceptability, feasibility, safety, and actual usage of an automated and manual PA telecoaching program following surgery for NSCLC. Methods: In this multicenter, single-blind study, patients received either an eight-week automated coaching program (ACP) with a customized smartphone app or a manual coaching program (MCP) with weekly phone calls from a coach. Both groups used an activity tracker, linked to their smartphone, to monitor steps and receive feedback. Primary outcomes included acceptability, feasibility, safety and usage, assessed via questionnaires and interviews. Secondary outcomes included objectively measured PA (accelerometry), functional exercise capacity (six-minute walk distance) and symptoms (dyspnea, fatigue) and quality of life, evaluated via questionnaires. Results: Nineteen patients (12 males; 68 ± 6 years; baseline daily steps 7820 ± 2799) were included. The majority (18/19) found the intervention enjoyable, and a minority (6/19) reported minor smartphone issues. All patients wore the activity tracker consistently. No adverse events occurred. The ACP required significantly less coach contact time compared to the MCP (25 ± 14 vs. 54 ± 15 min, p = 0.0003). No other differences in primary outcomes were observed between groups. Changes in secondary outcomes were limited in both groups. Conclusion: PA telecoaching is feasible, well accepted, and safe in patients with NSCLC post-surgery, with excellent activity tracker adherence. The ACP required less coach involvement. However, increasing PA remains challenging, and no conclusions can be made about the effectiveness of telecoaching. Future research should explore longer interventions in larger populations to assess efficacy and long-term outcomes. Full article

Background: Despite the well-documented physical and psychological benefits of regular physical activity (PA) and exercise, participation remains insufficient in adults with cystic fibrosis (pwCF). In the general population, PA enjoyment is a key determinant of sustained engagement, yet its predictors in CF populations remain underexplored. Objective: We aimed to examine associations between clinical parameters, health-related quality of life (HRQoL), motivation and PA enjoyment in adult pwCF. We hypothesised that higher intrinsic motivation and better HRQoL would predict greater enjoyment, independent of clinical parameters. Methods: In this cross-sectional study, 197 adult pwCF (mean age = 36.6 ± 11.9 years) from a single centre completed validated questionnaires assessing PA and exercise enjoyment (Physical Activity Enjoyment Scale, PACES), motivation (Behavioral Regulation in Exercise Questionnaire-2, BREQ-2), and HRQoL (Cystic Fibrosis Questionnaire-Revised, CFQ-R). Hierarchical regression was conducted in three steps: clinical variables (Model 1), added HRQoL domains (Model 2), and motivational variables (Model 3). Results: The complete model explained 68.4% of the variance in PA and exercise enjoyment (R² = 0.684, p < 0.001). Intrinsic motivation was the strongest positive predictor (β = 6.228, p < 0.001), while external regulation negatively predicted enjoyment (β = −1.932, p = 0.030). Among HRQoL domains, only health perception remained significant (β = 0.081, p = 0.038). Clinical variables alone accounted for minimal variance (R² = 0.023, p = 0.370). Conclusions: Intrinsic motivation was the most robust predictor of PA and exercise enjoyment, outweighing clinical and most HRQoL factors. These findings support autonomy-supportive strategies to foster internal motivation and enhance long-term PA and exercise participation in adult pwCF. Full article

Background: Dentinal hypersensitivity (DH) significantly impacts oral health-related quality of life. While global prevalence estimates range from 10–15%, region-specific data from Saudi Arabia remain limited. This study also aligns with Saudi Vision 2030’s mental health initiatives, as DH-associated anxiety impacts overall well-being. This study assessed DH prevalence and quality of life impact among Saudi adults. Methods: A cross-sectional online survey was conducted among 748 Saudi adults aged ≥ 18 years between April and May. Data were collected using a validated Arabic Dentinal Hypersensitivity Experience Questionnaire (DHEQ) alongside socio-demographic variables. Participants reporting DH symptoms within 12 months were included in impact analyses. Descriptive statistics and one-way ANOVA examined associations between DHEQ scores and participant characteristics. Results: Self-reported DH prevalence was 54.3% (n = 406), substantially exceeding global estimates. Among affected individuals, mean DHEQ score was 0.56 ± 0.19, indicating moderate-to-substantial quality-of-life impact. Functional limitations were most affected, particularly enjoyment of eating and drinking (0.72 ± 0.21). Significant associations were identified between higher DHEQ scores and age extremes (<18 and >35 years; p < 0.001), higher income levels (p = 0.032), fewer teeth (p = 0.040), and dental pain presence (p = 0.009). Sex, residence, education, and employment showed no significant associations. Conclusions: More than half of Saudi adults reported DH symptoms, representing a significant public health concern with substantial quality of life implications. Prevalence substantially exceeds global estimates, highlighting the need for targeted interventions. Age, income, tooth count, and pain presence emerged as key factors. These findings support developing population-specific prevention strategies, particularly targeting younger and older adults with tooth loss. Full article

High-quality green gardens can markedly enhance the quality of life and mental well-being of their users. However, health and lifestyle constraints make it difficult for people to enjoy urban gardens, and traditional methods struggle to offer the high-fidelity experiences they need. This study introduces a 3D scene reconstruction and rendering strategy based on implicit neural representation through the efficient and removable neural radiation fields model (NeRF-RE). Leveraging neural radiance fields (NeRF), the model incorporates a multi-resolution hash grid and proposal network to improve training efficiency and modeling accuracy, while integrating a segment-anything model to safeguard public privacy. Take the crabapple tree, extensively utilized in urban garden design across temperate regions of the Northern Hemisphere. A dataset comprising 660 images of crabapple trees exhibiting three distinct geometric forms is collected to assess the NeRF-RE model’s performance. The results demonstrated that the ‘harvest gold’ crabapple scene had the highest reconstruction accuracy, with PSNR, LPIPS and SSIM of 24.80 dB, 0.34 and 0.74, respectively. Compared to the Mip-NeRF 360 model, the NeRF-RE model not only showed an up to 21-fold increase in training efficiency for three types of crabapple trees, but also exhibited a less pronounced impact of dataset size on reconstruction accuracy. This study reconstructs real scenes with high fidelity using virtual reality technology. It not only facilitates people’s personal enjoyment of the beauty of natural gardens at home, but also makes certain contributions to the publicity and promotion of urban landscapes. Full article

Background/Objectives: Aging is often accompanied by physical and cognitive decline, affecting older adults’ mobility. Virtual reality (VR) offers innovative opportunities to safely practice everyday tasks, such as street crossing. This study was designed as a feasibility and pilot study to explore acceptance, usability, and preliminary effects of a VR-based road-crossing intervention for older adults. It investigates the use of virtual reality (VR) as an innovative training tool to support senior citizens in safely navigating everyday challenges such as crossing roads. By providing an immersive environment with realistic traffic scenarios, VR enables participants to practice in a safe and controlled setting, minimizing the risks associated with real-world road traffic. Methods: A VR training application called “Wegfest” was developed to facilitate targeted road-crossing practice. The application simulates various scenarios commonly encountered by older adults, such as crossing busy streets or waiting at traffic lights. The study applied a single-group pre-post design. Outcomes included the Timed Up and Go test (TUG), Falls Efficacy Scale-International (FES-I), and Montreal Cognitive Assessment (MoCA). Results: The development process of “Wegfest” demonstrates how a highly realistic street environment can be created for VR-based road-crossing training. Significant improvements were found in the Timed Up and Go test (p = 0.002, d = 0.784) and fall-related self-efficacy (FES-I, p = 0.005). No change was observed in cognitive function (MoCA, p = 0.56). Participants reported increased subjective safety (p < 0.001). Discussion: The development of the VR training application “Wegfest” highlights the feasibility of creating realistic virtual environments for skill development. By leveraging immersive technology, both physical and cognitive skills required for road-crossing can be effectively trained. The findings suggest that “Wegfest” has the potential to enhance the mobility and safety of older adults in road traffic through immersive experiences and targeted training interventions. Conclusions: As an innovative training tool, the VR application not only provides an engaging and enjoyable learning environment but also fosters self-confidence and independence among older adults in traffic settings. Regular training within the virtual world enables senior citizens to continuously refine their skills, ultimately improving their quality of life. Full article

Over the past decade, a growing body of evidence has highlighted the positive impact of full and equal participation in sport on the quality of life (QoL) of people with intellectual disabilities (IDs). However, access to mainstream sports remains limited due to persistent barriers, which leads to low participation levels among people with IDs. In this context, the Mixed Ability (MA) model offers an innovative approach by promoting the inclusion of people with and without disabilities in the same mainstream teams, without classification processes or modifications to the rules of the sport. Therefore, this study aimed to explore the relationship between rugby MA and the QoL and the needs of players with IDs. Using a convergent mixed methods design, the quantitative aspect involved 46 participants aged 18–57, engaged in eight different rugby teams, while the qualitative component included a focus group with four ID players from a rugby team. The findings revealed a positive correlation between higher QoL and the duration of participation in mainstream sports among the participants. Furthermore, a positive trend was also observed among individuals with moderate and severe intellectual disabilities. Qualitatively, participants highlighted the model’s emphasis on inclusivity, familial bonds, enjoyment, community spirit, active engagement, and opportunities to experience new activities. The shift towards inclusion requires modifying the community so that every person has opportunities to lead a valuable, meaningful, and self-determined life. In this sense, the MA sports model emerges as a potent instrument for fostering inclusive communities and enhancing the QoL of people with IDs. Full article

Headache represents one of the most prevalent and disabling conditions in the pediatric population, with significant repercussions on mental and psychological well-being, as well as on academic achievement and social functioning, ultimately leading to a marked reduction in quality of life. Currently, the diagnosis of headache is based on the clinical criteria of the third edition of the International Classification of Headache Disorders (ICHD-3). However, the characteristics of headache may differ between adults and children, as well as the ability of children to provide a complete description of the pain and associated symptoms. The immature narrative skills of children can represent a limitation in defining the clinical phenotype of headache, making the diagnosis more complex. This is even more challenging when extracting information about the characteristics of the headache in children whose verbal expression is poorly developed or completely absent. Given these limitations, clinical psychology has long used drawing as an effective diagnostic instrument to bypass verbal communication barriers. This tool provides unique access to children’s psychological and emotional states, as a direct window into their inner world and as an expressive medium that often generates more detailed, accurate, and clinically actionable information, compared to verbal reports alone. For these reasons, drawing has been recognized as a valuable diagnostic tool for decades, with multiple studies demonstrating specificity and accuracy rates comparable to standard clinical assessments. Particularly for young children, drawings may give access to fundamental information that might otherwise remain inaccessible, thereby allowing both accurate diagnosis and individualized treatment planning. Multiple studies have highlighted and confirmed the graphic differences between representations of various types of headaches and the undeniable utility of an “artistic diagnosis” alongside the clinical one. Furthermore, the literature suggests and encourages the use of drawing in clinical practice, both in the diagnostic process and during subsequent follow-up, as an effective, enjoyable, easy-to-use, and low-cost resource. Accordingly, we propose a narrative review accompanied by a curated collection of drawings that may help identify and categorize specific correlations between graphic representations and clinical phenotypes, such as pain location, quality, intensity, association with nausea and vomiting, photophobia and phonophobia, and types of migraine aura. Our goal is to create a visual reference that can aid clinicians in the accurate interpretation of children’s drawings. Additionally, we aim to promote the integration of this method into routine clinical practice to improve diagnostic precision and support a more child-centered model of care. We also hope to propose new iconographic models to further enrich the diagnostic framework. Full article

Background/Objectives: Adverse effects of antipsychotics represent a significant limiting factor in achieving favorable therapeutic outcomes in the treatment of schizophrenia, and may contribute to a diminished quality of life among affected individuals. The primary objective of this study was to identify and evaluate the adverse effects of antipsychotics in patients diagnosed with schizophrenia who were treated at the social welfare institution, as well as to analyze the impact of these adverse effects on patients’ overall quality of life. Methods: A clinical, observational cross-sectional study was conducted, involving a sample of 278 patients diagnosed with schizophrenia. The patients were assessed in terms of their sociodemographic and clinical characteristics. Adverse effects of antipsychotics were evaluated using The Udvalg for Kliniske Undersøgelser (UKU) Side Effect Rating Scale, while quality of life was assessed in the previous study. Results: The average number of adverse effects per patient with schizophrenia was 3.56 for psychiatric, 1.18 for neurological, 2.62 for autonomic, and 7.12 for other side effects. The average UKU score was 17.22 ± 11.04, with significant differences based on accommodation, antipsychotic type, and dosing regimen. UKU scores were negatively correlated with the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) index, Visual Analog Scale (VAS) score, the Quality-of-Life Enjoyment and Satisfaction Questionnaire—Short Form (Q-LES-Q-SF) score, and the scores of physical and psychological domains of the World Health Organization Quality-of-Life Scale (WHOQOL-BREF). Conclusions: The findings of this study suggest that the presence of antipsychotic-related adverse effects is a significant determinant that can negatively influence the quality of life in patients with schizophrenia. These results underscore the importance of an individualized approach when determining pharmacological treatment strategies in the management of schizophrenia. Full article

Cultural tourism can act as a driver for inner area development, bringing about a range of socio-economic benefits through economic stimulation, quality of life improvement, and cultural heritage preservation. Inner territories, set apart by geographic marginality and low population density, hold a rich cultural and environmental heritage that, however, remains off the radar and left behind. Guided by the principles of endogenous local development, this article seeks to contribute to the existing body of research by proposing potential strategies for local growth rooted in cultural tourism. From this perspective, we identified the Basilicata region (Southern Italy) as a proper test area. The region is rich in archaeological, monumental and museum evidence, but is characterized, except in a few areas, by a low rate of tourist turnout. Through a replicable, comprehensive, and flexible methodology—drawing on bibliographic research, analysis of archaeological, archival, erudite and antiquarian sources, and carrying out field surveys—the different points of interest in the region have been brought together under specific cultural themes. Results include the design of three detailed routes (Via Herculia, Frederick II’s, and St Michael’s cultural routes) useful for three different types of tourism (sustainable, emotional, and accessible). Possible scenarios for valorization and fruition are also proposed, paying particular attention to digital technologies. Thus, this research aligns with Sustainable Development Goals (SDGs) 8 and 11 promoting cultural heritage valorization and preservation, shoring up economic revitalization, stepping up community engagement, and pushing forward environmentally friendly tourism practices. Research findings can attract the interest of a wide range of stakeholders such as tourism professionals, local authorities, cultural and creative industries, local communities and entrepreneurs, as well as academics and researchers. The methodological approach can be considered for the valorization and tourist enjoyment of inner areas in other countries, with particular focus on those falling within the Mediterranean region which is rich in cultural heritage, environmental value, and socio-economic potential. Full article

Background/Objectives: Aquagym is a form of practicing aerobic gymnastics to stay fit, which is constantly progressing in line with the dynamics of market growth and the fitness industry, bringing benefits to physical and mental health. The purpose of the study was to identify the level of popularity of this sport among people aged 20–65 years and to highlight the benefits of practicing aquagym. Methods: This quantitative research study was designed to use a structured questionnaire to collect data from 150 participants. The sample was chosen to reflect various age groups and to ensure representativeness for the general population interested in physical activity. Participants were divided by gender into two age categories, under 45 and over 45, in order to examine differences in preferences and perceptions between these age segments. For the analysis of between-group differences, we used the Chi-Square and Cramer’s V tests, and for the profile of respondents, a Two-Step Cluster Analysis was applied. Results: Regarding knowledge of the aquagym concept, there is a notable discrepancy between females and males, with significantly more women (54%) than men (18%) stating that they are familiar with this concept. Among the perceived benefits of water gymnastics, most responses indicate maintaining muscle tone (25% women and 14% men) and a fun way to stay fit (20% women and 11% men). Young people under 45 years of age tend to attach more importance to the social and entertaining aspects of aquagym. As for the improvement in quality of life by practicing water gymnastics, a large number of respondents (82%) rated this contribution with a score of 4 or 5 on a 5-point scale, meaning that the positive impact of this activity was highly appreciated. Conclusions: Aquagym lessons are perceived as both an effective form of exercise for health improvement and a means of socialization. The outcomes of the study highlight the opportunity to continuously promote and develop gymnastics in the aquatic environment as an accessible and enjoyable form of physical activity for all ages. Full article

Background: Eating behavior problems significantly affect the physical health and quality of life of children with autism spectrum disorder and intellectual disabilities (co-occurring ASD/ID). This study aimed to evaluate the effects of a 12-week Ball Combination Training Program (BCTP), continuous theta burst stimulation (cTBS), and an intervention combining both (in the CIG) on the eating behaviors of children with co-occurring ASD/ID. Methods: A total of 48 participants were assigned into one of four groups: the BCTP (n = 13), cTBS (n = 12), the CIG (n = 11), and a control group (n = 12). The intervention groups received their respective treatments in addition to the routine institutional rehabilitation, whereas the control group only received the standard institutional rehabilitation. The intervention outcomes were assessed using the parent-reported Children’s Eating Behavior Questionnaire (CEBQ). Results: The results indicated that all three intervention methods led to improvements in their eating behavior after 12 weeks. Specifically, the BCTP group and the CIG demonstrated significantly reduced Food Fussiness behavior, while the children’s Enjoyment of Food was markedly enhanced in the cTBS group and the CIG. Furthermore, the CIG experienced a particularly notable effect in terms of the improvement in the Satiety Responsiveness dimension of their eating behavior. Among the three approaches, the CIG demonstrated a clear advantage over the single interventions in terms of both the breadth and magnitude of its improvements. Conclusions: This study confirmed the effectiveness of these three intervention strategies in addressing dietary behavior problems among children with co-occurring ASD/ID. Future research should focus on exploring the combined intervention approach further, particularly its potential synergy, while delving deeper into the neural mechanisms underlying these behavioral improvements. Full article

Background: Cervical cancer is the fourth leading cause of cancer-related mortality among women globally and remains a prevalent malignancy among Emirati women. This study assessed the quality of life of Emirati women with cervical cancer and identified key factors influencing their well-being to inform targeted interventions. Methods: A cross-sectional study was conducted among 72 Emirati women diagnosed with cervical cancer utilizing the Arabic-translated European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30 and QLQ-CX24). Sociodemographic and clinical data were collected. Statistical analyses included ANOVA, independent-sample t-tests, and, where assumptions were violated, Kruskal–Wallis and Mann–Whitney tests. Results: The mean global health status/QoL score was 64.4 (SD ± 20.4), indicating moderate well-being. The cognitive (69.9 ± 23.5) and role functioning (65.1 ± 25.0) scores were relatively high, whereas the social functioning score was lower (61.8 ± 25.2). Fatigue (41.5 ± 27.5), sleep disturbance (40.7 ± 31.3), and pain (39.4 ± 27.6) were the most prevalent symptoms. Radiotherapy negatively impacted sexual enjoyment (p = 0.019), whereas lower income and metastases were associated with worse symptom burden. Higher education, employment, and physical activity correlated positively with functional well-being. Conclusions: Early-stage diagnosis, financial stability, and physical activity were key predictors of better QoL. Addressing financial disparities, managing symptoms, and improving survivorship care are essential. Full article

Low social affiliation has been described as a phenotypic marker of antisocial behaviors by disrupting children’s initiation and enjoyment of positive physical and emotional connections with others. Laboratory studies have shown that, in early childhood, low social affiliation rates are preceded by lower attention to faces. In addition, while low social affiliation has also been associated with behavioral outcomes when accounting for parenting influences, the effect that parental environmental sensitivity may have on contributing to the link between emotional processing early in life and later behavioral manifestations associated with antisocial behavior is currently unknown. Objectives: The present eye-tracking study aims to delineate the potential contribution of parental Sensory Processing Sensitivity (SPS) to the link between children’s rates of social affiliation and their attentional patterns in response to emotional faces. Methods: For the needs of this study, children performed a lab-based, computerized facial processing task (N = 153; Mage = 9.97; SDage = 1.28; 48.8% females). In addition, one of the children’s parents completed questionnaires for their children’s and their own behavior (N = 153; Mage = 40.9; SDage = 4.85; 87.7% females). Results: The results underline the contributing role of parental SPS on the associations between social affiliation and visual scanning when viewing angry emotional faces. In particular, children with low rates of social affiliation spent significantly more time fixating on the mouth regions of angry faces only when their parents had higher SPS. Conclusions: This study unveils the possibility for the contextual influence of parental environmental sensitivity on the early emotional processing mechanisms in children with low rates of social affiliation. These findings suggest that interventions aimed at improving emotional processing in children at risk for antisocial behavior should consider parental SPS as a contributing factor. Tailoring parent-based interventions to address how highly sensitive parents interpret and respond to emotional challenges may reduce children’s attentional biases to threats and support healthier socioemotional development. Full article